Provider Demographics
NPI:1336192103
Name:LAKEVIEW VILLAGE, INC
Entity Type:Organization
Organization Name:LAKEVIEW VILLAGE, INC
Other - Org Name:LAKEVIEW VILLAGE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:CLAUSEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPA
Authorized Official - Phone:913-744-2470
Mailing Address - Street 1:9100 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-3353
Mailing Address - Country:US
Mailing Address - Phone:913-888-1900
Mailing Address - Fax:913-888-4141
Practice Address - Street 1:9100 PARK ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3353
Practice Address - Country:US
Practice Address - Phone:913-888-1900
Practice Address - Fax:913-888-4141
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKEVIEW VILLAGE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251E00000X
KSA-046-091251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
177286Medicare Oscar/Certification