Healthcare Provider Details

I. General information

NPI: 1083924732
Provider Name (Legal Business Name): LAKEVIEW CARE PARTNERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 09/02/2025
Certification Date: 03/29/2024
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 Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDY OLIVARES
Title or Position: PRESIDENT/COO
Credential:
Phone: 262-534-7297