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General NPI Number Information
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NPI Number | 1023140415
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Entity Type | Organization
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Legal Business Name | LAKEVIEW OCEAN STATE, INC.
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 07/09/2009
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Provider Practice Location Address
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Address Line | 4219 S COUNTY TRL
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City | CHARLESTOWN
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State | RI
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Zip | 02813-3628
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Country | US
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Telephone | 401-364-8719
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Fax |
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Provider Business Mailing Address
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Address Line | 244 HIGH WATCH RD
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City | EFFINGHAM
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State | NH
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Zip | 03882-8336
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Country | US
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Telephone | 603-539-7451
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CHRIS SLOVER
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Credential |
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Telephone | 603-539-7451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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