Healthcare Provider Details

I. General information

NPI: 1477886711
Provider Name (Legal Business Name): LAKEVIEW AFCH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E BROADWAY
LINCOLN ME
04457
US

IV. Provider business mailing address

10 E BROADWAY
LINCOLN ME
04457
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-2896
  • Fax:
Mailing address:
  • Phone: 207-794-2896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberALLS3642
License Number StateME

VIII. Authorized Official

Name: THOMAS STEPANEC
Title or Position: OWNER
Credential:
Phone: 207-794-2896