Provider Demographics
NPI:1780718916
Name:LAKEPOINT AUGUSTA, LLC
Entity type:Organization
Organization Name:LAKEPOINT AUGUSTA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LAVALLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-775-6333
Mailing Address - Street 1:901 LAKEPOINT DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010
Mailing Address - Country:US
Mailing Address - Phone:316-776-2194
Mailing Address - Fax:316-776-9370
Practice Address - Street 1:901 LAKEPOINT DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-2423
Practice Address - Country:US
Practice Address - Phone:316-776-2194
Practice Address - Fax:316-776-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100108500BMedicaid