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General NPI Number Information
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NPI Number | 1770422149
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Entity Type | Organization
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Legal Business Name | LAKE VIEW TERRACE MANAGEMENT LLC
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Dates
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Enumeration Date | 03/27/2026
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Last Update Date | 03/27/2026
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Provider Practice Location Address
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Address Line | 320 LAKE HAVASU AVE N
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-4701
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Country | US
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Telephone | 928-855-8099
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Fax | 928-855-6666
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Provider Business Mailing Address
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Address Line | 13455 KNAUS RD
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City | LAKE OSWEGO
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State | OR
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Zip | 97034-2161
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Country | US
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Telephone | 928-855-8099
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Fax | 928-855-6666
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Authorized Official
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Title or Position | CEO
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Name | TARA KILLINGER-WELLE
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Credential |
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Telephone | 971-533-0851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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