Healthcare Provider Details

I. General information

NPI: 1447733480
Provider Name (Legal Business Name): CHC LAKESIDE NURSING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 WILLOW RUN ST
LAKE CITY AR
72437-9520
US

IV. Provider business mailing address

305 HIGHWAY 64 E STE D
AUGUSTA AR
72006-5158
US

V. Phone/Fax

Practice location:
  • Phone: 870-237-8151
  • Fax: 870-237-4011
Mailing address:
  • Phone: 870-347-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BOYD WRIGHT
Title or Position: COO
Credential:
Phone: 870-347-0001