Provider Demographics
NPI:1205654738
Name:LAKESHORE HEALTH AND REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:LAKESHORE HEALTH AND REHABILITATION CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MENACHEM
Authorized Official - Middle Name:
Authorized Official - Last Name:RUVEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-605-9800
Mailing Address - Street 1:5837 LYONS VIEW PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6474
Mailing Address - Country:US
Mailing Address - Phone:865-584-3902
Mailing Address - Fax:865-584-2122
Practice Address - Street 1:5837 LYONS VIEW PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6474
Practice Address - Country:US
Practice Address - Phone:865-584-3902
Practice Address - Fax:865-584-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility