MEDICARE: LAKEWOOD HEALTH CARE CENTER, 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
1	310400000X	Assisted Living Facility	0506R	OH

General Provider Information

NPI Number	:	1134514961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWOOD HEALTH CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	13323 DETROIT AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-2849
Country	:	US
Telephone Number	:	216-226-3858
Fax Number	:	216-226-8344

Provider Business Practice Location Address
First Line	:	13323 DETROIT AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-2849
Country	:	US
Telephone Number	:	216-226-3858
Fax Number	:	216-226-8344

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MRS. PATRICE CAMPBELL
Credential	:	LNHA
Telephone Number	:	216-226-3858

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	06/26/2019

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