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General NPI Number Information
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NPI Number | 1205654738
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Entity Type | Organization
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Legal Business Name | LAKESHORE HEALTH AND REHABILITATION CENTER LLC
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 5837 LYONS VIEW PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37919-6474
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Country | US
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Telephone | 865-584-3902
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Fax | 865-584-2122
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Provider Business Mailing Address
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Address Line | 5837 LYONS VIEW PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37919-6474
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Country | US
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Telephone | 865-584-3902
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Fax | 865-584-2122
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MENACHEM RUVEL
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Credential |
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Telephone | 516-605-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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