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General NPI Number Information
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NPI Number | 1891791927
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Entity Type | Organization
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Legal Business Name | LAKESIDE BEIKIRCH CARE CENTER, INC.
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 09/03/2015
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Provider Practice Location Address
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Address Line | 170 WEST AVE
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City | BROCKPORT
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State | NY
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Zip | 14420-1227
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Country | US
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Telephone | 585-395-6052
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Fax | 585-395-6007
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Provider Business Mailing Address
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Address Line | 170 WEST AVE
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City | BROCKPORT
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State | NY
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Zip | 14420-1227
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Country | US
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Telephone | 585-395-6052
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Fax | 585-395-6007
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KIMBERLY KLINETOB
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Credential |
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Telephone | 585-395-6095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 2752301N
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2752301N
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License Number State | NY
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