Provider Demographics
NPI:1932109915
Name:LAKEPOINT EL DORADO LLC
Entity Type:Organization
Organization Name:LAKEPOINT EL DORADO LLC
Other - Org Name:D/B/A LAKEPOINT NURSING & REHABILITATION CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAVALLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-775-6333
Mailing Address - Street 1:1313 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-3751
Mailing Address - Country:US
Mailing Address - Phone:316-321-4140
Mailing Address - Fax:316-321-7690
Practice Address - Street 1:1313 S HIGH ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3751
Practice Address - Country:US
Practice Address - Phone:316-321-4140
Practice Address - Fax:316-321-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN008002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1041078201Medicaid
KS175124Medicare ID - Type Unspecified