Provider Demographics
NPI:1891384558
Name:LAKESHORE MANOR NURSING & REHAB LLC
Entity Type:Organization
Organization Name:LAKESHORE MANOR NURSING & REHAB LLC
Other - Org Name:TRINITY NEUROLOGIC REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:COURVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-960-7877
Mailing Address - Street 1:9026 JEFFERSON HIGHWAY, BUILDING 5, SUITE 502
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-960-7877
Mailing Address - Fax:225-529-3720
Practice Address - Street 1:1400 LINDBERG DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8056
Practice Address - Country:US
Practice Address - Phone:985-641-4985
Practice Address - Fax:985-646-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility