Provider Demographics
NPI:1932139441
Name:LAKEVIEW HEALTHCARE, INC
Entity Type:Organization
Organization Name:LAKEVIEW HEALTHCARE, INC
Other - Org Name:QUEEN CITY NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-831-3001
Mailing Address - Street 1:16411 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4879
Mailing Address - Country:US
Mailing Address - Phone:228-831-3001
Mailing Address - Fax:228-831-0408
Practice Address - Street 1:1201 28TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3810
Practice Address - Country:US
Practice Address - Phone:601-483-1467
Practice Address - Fax:601-483-1483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11731314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00230008Medicaid
MS00230008Medicaid