Provider Demographics
NPI:1396726873
Name:LAKEVIEW NEUROREHAB CENTER MIDWEST, INC
Entity type:Organization
Organization Name:LAKEVIEW NEUROREHAB CENTER MIDWEST, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:511-773-8076
Mailing Address - Street 1:1701 SHARP RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-5214
Mailing Address - Country:US
Mailing Address - Phone:262-534-7297
Mailing Address - Fax:262-534-7257
Practice Address - Street 1:1701 SHARP RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-5214
Practice Address - Country:US
Practice Address - Phone:262-534-7297
Practice Address - Fax:262-534-7257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X, 283X00000X, 323P00000X, 282E00000X
WI3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
No283X00000XHospitalsRehabilitation Hospital
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11022100Medicaid
WI11022181Medicaid
WI11022100Medicaid