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General NPI Number Information
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NPI Number | 1639501141
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Entity Type | Organization
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Legal Business Name | LAKEWOOD LANDING, INC.
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 4401 21ST ST SE
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City | MANDAN
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State | ND
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Zip | 58554
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Country | US
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Telephone | 701-751-6191
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Fax |
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Provider Business Mailing Address
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Address Line | 4401 21ST ST SE
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City | MANDAN
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State | ND
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Zip | 58554
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Country | US
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Telephone | 701-751-6191
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Fax |
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | MS. SUSAN BALA
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Credential |
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Telephone | 218-790-6427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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