Healthcare Provider Details

I. General information

NPI: 1396726873
Provider Name (Legal Business Name): LAKEVIEW NEUROREHAB CENTER MIDWEST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SHARP RD
WATERFORD WI
53185-5214
US

IV. Provider business mailing address

1701 SHARP RD
WATERFORD WI
53185-5214
US

V. Phone/Fax

Practice location:
  • Phone: 262-534-7297
  • Fax: 262-534-7257
Mailing address:
  • Phone: 262-534-7297
  • Fax: 262-534-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateWI

VIII. Authorized Official

Name: CHRISTOPHER SCOTT SLOVER
Title or Position: CEO
Credential:
Phone: 511-773-8076