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General NPI Number Information
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NPI Number | 1497244693
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Entity Type | Organization
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Legal Business Name | LAKE LAGOS CARE LLC
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Dates
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Enumeration Date | 05/03/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1416 COUNTRY CLUB RD
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City | ENNIS
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State | TX
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Zip | 75119-2252
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Country | US
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Telephone | 469-383-4776
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Fax | 214-723-5928
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Provider Business Mailing Address
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Address Line | 1416 COUNTRY CLUB RD
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City | ENNIS
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State | TX
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Zip | 75119-2252
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Country | US
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Telephone | 469-383-4776
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Fax | 214-723-5928
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | SARAH ANNETTE KNAVEL ISOLA
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Credential |
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Telephone | 469-383-4776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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