Provider Demographics
NPI:1972841807
Name:LAKEVIEW PRIMARY HOMECARE LLC
Entity Type:Organization
Organization Name:LAKEVIEW PRIMARY HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:NWEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-900-5323
Mailing Address - Street 1:9304 FOREST LN STE N254
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6238
Mailing Address - Country:US
Mailing Address - Phone:214-900-5323
Mailing Address - Fax:972-807-9186
Practice Address - Street 1:9304 FOREST LN STE N254
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:214-900-5323
Practice Address - Fax:214-594-7421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2018-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX0155653747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty