Healthcare Provider Details

I. General information

NPI: 1487644464
Provider Name (Legal Business Name): LAKEVIEW CHRISTIAN HOME OF THE SOUTHWEST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N CANAL ST
CARLSBAD NM
88220-4600
US

IV. Provider business mailing address

1905 W PIERCE ST
CARLSBAD NM
88220-4025
US

V. Phone/Fax

Practice location:
  • Phone: 505-887-3947
  • Fax: 505-234-1905
Mailing address:
  • Phone: 505-887-3947
  • Fax: 505-234-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6567
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number5088
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5553
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5088
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number3000
License Number StateNM

VIII. Authorized Official

Name: MS. JOANNA D. KNOX
Title or Position: C.E.O.
Credential:
Phone: 505-887-3947