Healthcare Provider Details

I. General information

NPI: 1932109915
Provider Name (Legal Business Name): LAKEPOINT EL DORADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 S HIGH ST
EL DORADO KS
67042-3751
US

IV. Provider business mailing address

1313 S HIGH ST
EL DORADO KS
67042-3751
US

V. Phone/Fax

Practice location:
  • Phone: 316-321-4140
  • Fax: 316-321-7690
Mailing address:
  • Phone: 316-321-4140
  • Fax: 316-321-7690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN008002
License Number StateKS

VIII. Authorized Official

Name: MRS. CHERYL L LAVALLEE
Title or Position: COO
Credential:
Phone: 316-775-6333