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General NPI Number Information
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NPI Number | 1497741276
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Entity Type | Organization
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Legal Business Name | LAKE LODGE NURSING AND REHABILITATION LP
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 3800 MARINA DR
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City | LAKE WORTH
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State | TX
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Zip | 76135-2835
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Country | US
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Telephone | 817-237-7231
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Fax | 817-237-5086
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Provider Business Mailing Address
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Address Line | 419 S ELM ST
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City | DENTON
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State | TX
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Zip | 76201-6085
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Country | US
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Telephone | 940-387-4388
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Fax | 940-380-2410
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Authorized Official
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Title or Position | CEO
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Name | MR. DAN D. FLAGG
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Credential |
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Telephone | 940-387-4388
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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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