Healthcare Provider Details

I. General information

NPI: 1932139441
Provider Name (Legal Business Name): LAKEVIEW HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 28TH AVE
MERIDIAN MS
39301-3810
US

IV. Provider business mailing address

16411 ROBINSON RD
GULFPORT MS
39503-4879
US

V. Phone/Fax

Practice location:
  • Phone: 601-483-1467
  • Fax: 601-483-1483
Mailing address:
  • Phone: 228-831-3001
  • Fax: 228-831-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number11731
License Number StateMS

VIII. Authorized Official

Name: MR. BRIAN K CAIN
Title or Position: PRESIDENT
Credential:
Phone: 228-831-3001