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General NPI Number Information
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NPI Number | 1528386091
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Entity Type | Organization
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Legal Business Name | LAKEWOOD HOSPITAL LLC
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Dates
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Enumeration Date | 05/08/2010
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Last Update Date | 05/08/2010
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Provider Practice Location Address
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Address Line | 1001 DICKERSON DR
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City | JASPER
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State | TX
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Zip | 75951-5110
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Country | US
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Telephone | 713-661-0001
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Fax | 713-669-4862
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Provider Business Mailing Address
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Address Line | 8800 S MAIN ST
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City | HOUSTON
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State | TX
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Zip | 77025-2707
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Country | US
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Telephone | 713-661-0001
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Fax | 713-669-4862
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Authorized Official
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Title or Position | DIRECTOR OF NURSING
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Name | MS. OLATOKUNBO IFAYEMI ODUTAYO
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Credential | R.N.
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Telephone | 832-859-3932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | K 6196
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License Number State | TX
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