Provider Demographics
NPI:1720081052
Name:LAKEVIEW CORPORATION
Entity Type:Organization
Organization Name:LAKEVIEW CORPORATION
Other - Org Name:LAKEVIEW NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:228-831-3001
Mailing Address - Street 1:16411 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4879
Mailing Address - Country:US
Mailing Address - Phone:228-831-3001
Mailing Address - Fax:228-831-0408
Practice Address - Street 1:16411 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4879
Practice Address - Country:US
Practice Address - Phone:228-831-3001
Practice Address - Fax:228-831-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS735314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00230088Medicaid
MS255182Medicare Oscar/Certification