Healthcare Provider Details

I. General information

NPI: 1679565550
Provider Name (Legal Business Name): LAKEWOOD HEALTH CARE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 MAELOU DR
HAMBURG NY
14075-7419
US

IV. Provider business mailing address

5775 MAELOU DR
HAMBURG NY
14075-7419
US

V. Phone/Fax

Practice location:
  • Phone: 716-648-2820
  • Fax: 716-648-2980
Mailing address:
  • Phone: 716-648-2820
  • Fax: 716-648-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1430302N
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00872028
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: MRS. DARLENE GALE
Title or Position: DIRECTOR OF ACCOUNTS RECEIVABLE
Credential:
Phone: 716-633-0021