Provider Demographics
NPI:1841548708
Name:LAKEVIEW REHAB AT HOME INC
Entity type:Organization
Organization Name:LAKEVIEW REHAB AT HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-973-9700
Mailing Address - Street 1:507 S MARKET ST
Mailing Address - Street 2:SUITE T1
Mailing Address - City:WESTFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53964-9046
Mailing Address - Country:US
Mailing Address - Phone:603-296-4195
Mailing Address - Fax:603-296-4203
Practice Address - Street 1:507 S MARKET ST
Practice Address - Street 2:SUITE T1
Practice Address - City:WESTFIELD
Practice Address - State:WI
Practice Address - Zip Code:53964-9046
Practice Address - Country:US
Practice Address - Phone:603-296-4195
Practice Address - Fax:603-296-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1141251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health