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General NPI Number Information
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NPI Number | 1699771089
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Entity Type | Organization
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Legal Business Name | LAKEWOOD HEALTH CARE CENTER, INC.
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 06/26/2019
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Provider Practice Location Address
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Address Line | 13315 DETROIT AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-2849
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Country | US
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Telephone | 216-226-3858
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Fax | 216-226-8344
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Provider Business Mailing Address
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Address Line | 13315 DETROIT AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-2849
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Country | US
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Telephone | 216-226-3858
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Fax | 216-226-8344
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. PATRICE M. CAMPBELL
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Credential | LNHA
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Telephone | 216-226-3858
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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 | 5803
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 4943
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 4943
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License Number State | OH
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