Healthcare Provider Details

I. General information

NPI: 1336192103
Provider Name (Legal Business Name): LAKEVIEW VILLAGE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 PARK ST
LENEXA KS
66215-3353
US

IV. Provider business mailing address

9100 PARK ST
LENEXA KS
66215-3353
US

V. Phone/Fax

Practice location:
  • Phone: 913-888-1900
  • Fax: 913-888-4141
Mailing address:
  • Phone: 913-888-1900
  • Fax: 913-888-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberA-046-091
License Number StateKS

VIII. Authorized Official

Name: MR. ROBERT I CLAUSEN JR.
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 913-744-2470