Provider Demographics
NPI:1831191147
Name:LAKEVIEW METHODIST HEALTH CARE CENTER
Entity type:Organization
Organization Name:LAKEVIEW METHODIST HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-235-6606
Mailing Address - Street 1:610 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-2247
Mailing Address - Country:US
Mailing Address - Phone:507-235-6606
Mailing Address - Fax:507-235-6767
Practice Address - Street 1:610 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-2247
Practice Address - Country:US
Practice Address - Phone:507-235-6606
Practice Address - Fax:507-235-6767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN245280314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
245280Medicare ID - Type UnspecifiedMEDICARE ID