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NPI Code Detail

MEDICARE: LAKEVIEW MANOR INC

MEDICARE: LAKEVIEW MANOR INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility379LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013998442
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKEVIEW MANOR INC
Provider Business Mailing Address
First Line : PO BOX 320
Second Line :
City : NEW ROADS
State : LA
Zip : 70760-0320
Country : US
Telephone Number : 225-638-4404
Fax Number : 225-638-8607
Provider Business Practice Location Address
First Line : 400 HOSPITAL RD
Second Line :
City : NEW ROADS
State : LA
Zip : 70760-2623
Country : US
Telephone Number : 225-638-4404
Fax Number : 225-638-8607
Authorized Official
Title or Position : OWNER CEO
Name : MR. MELVIN J HARRIS
Credential :
Telephone Number : 318-253-6536
Provider Enumeration Date : 11/11/2005
Last Update Date : 08/09/2007

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Directions to “LAKEVIEW MANOR INC ” Practice Location

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