Provider Demographics
NPI:1720865165
Name:LAKEWOOD PLACE, LLC
Entity Type:Organization
Organization Name:LAKEWOOD PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE YP OF OPERATIONS & CLINIC
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:LANDIS
Authorized Official - Last Name:TRENTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-293-6563
Mailing Address - Street 1:1125 GROVE STREET
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774
Mailing Address - Country:US
Mailing Address - Phone:865-458-4123
Mailing Address - Fax:865-458-0960
Practice Address - Street 1:1125 GROVE STREET
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774
Practice Address - Country:US
Practice Address - Phone:865-458-4123
Practice Address - Fax:865-458-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility