MEDICARE: LAKEWOOD HEALTH CARE AGENCY 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	251E00000X	Home Health Agency		TX

General Provider Information

NPI Number	:	1427473867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWOOD HEALTH CARE AGENCY INC

Provider Business Mailing Address
First Line	:	1918 SANTA ANNA DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-5611
Country	:	US
Telephone Number	:	817-201-4503
Fax Number	:	817-642-5314

Provider Business Practice Location Address
First Line	:	1918 SANTA ANNA DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-5611
Country	:	US
Telephone Number	:	817-201-4503
Fax Number	:	817-642-5314

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	YONAH KNUCKLES
Credential	:	RN
Telephone Number	:	817-201-4503

Provider Enumeration Date	:	02/21/2014
Last Update Date	:	02/21/2014

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