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General NPI Number Information
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NPI Number | 1972505949
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Entity Type | Organization
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Legal Business Name | LAKEWOOD NURSING CENTER INC
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 100 N LAKE ST
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City | CRESCENT CITY
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State | FL
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Zip | 32112-2620
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Country | US
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Telephone | 386-698-2222
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Fax | 386-698-2717
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Provider Business Mailing Address
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Address Line | 100 N LAKE ST
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City | CRESCENT CITY
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State | FL
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Zip | 32112-2620
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Country | US
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Telephone | 386-698-2222
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Fax | 386-698-2717
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT W HAGAN
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Credential |
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Telephone | 770-993-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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