Healthcare Provider Details

I. General information

NPI: 1801811609
Provider Name (Legal Business Name): LAKEWOOD HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 LAKEPARK DRIVE
HOT SPRINGS AR
71901
US

IV. Provider business mailing address

260 LAKEPARK DRIVE
HOT SPRINGS AR
71901
US

V. Phone/Fax

Practice location:
  • Phone: 501-262-1920
  • Fax: 501-262-5237
Mailing address:
  • Phone: 501-262-1920
  • Fax: 501-262-5237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number024
License Number StateAR

VIII. Authorized Official

Name: DEBORAH A TYLER
Title or Position: ADMINISTRATOR
Credential: LPN, LNHA
Phone: 501-262-1920