Provider Demographics
NPI:1215057831
Name:LAKEVIEW SUBACUTE CARE CENTER, INC.
Entity type:Organization
Organization Name:LAKEVIEW SUBACUTE CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:GROSSO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LNHA
Authorized Official - Phone:973-616-5815
Mailing Address - Street 1:130 TERHUNE DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7104
Mailing Address - Country:US
Mailing Address - Phone:973-616-5815
Mailing Address - Fax:973-616-2768
Practice Address - Street 1:130 TERHUNE DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7104
Practice Address - Country:US
Practice Address - Phone:973-616-5815
Practice Address - Fax:973-616-2768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ61610314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
0047847OtherAETNA USHC
0047847OtherAETNA PPO
92624OtherAMERIGROUP
ANC268OtherOXFORD HEALTH
4552OtherAMERIHEALTH
CV09616OtherCIGNA
NJ315110OtherBLUE CROSS BLUE SHIELD
NJ4496205Medicaid
92624OtherAMERIGROUP
=========OtherMAGNACARE
NJ4496205Medicaid
0047847OtherAETNA PPO
=========OtherPARADIGM
=========OtherAARP
CV09616OtherCIGNA
TN315110Medicare ID - Type Unspecified