Healthcare Provider Details

I. General information

NPI: 1891654364
Provider Name (Legal Business Name): LAKEVIEW CONGREGATE FACILITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 LAKEVIEW ST
BEAUMONT CA
92223-8506
US

IV. Provider business mailing address

1523 LAKEVIEW ST
BEAUMONT CA
92223-8506
US

V. Phone/Fax

Practice location:
  • Phone: 408-705-3008
  • Fax: 818-688-0272
Mailing address:
  • Phone: 408-705-3008
  • Fax: 818-688-0272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SRI AIYASWAMY
Title or Position: ADMINISTRATOR DESIGNEE
Credential:
Phone: 408-705-3008