MEDICARE: LAKEVIEW HEALTHCARE SYSTEMS WATERFORD

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1508042961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEVIEW HEALTHCARE SYSTEMS WATERFORD

Provider Business Mailing Address
First Line	:	2011 RUTLAND DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-5421
Country	:	US
Telephone Number	:	512-973-9700
Fax Number	:	512-857-0504

Provider Business Practice Location Address
First Line	:	5310 BUENA PARK RD
Second Line	:
City	:	WATERFORD
State	:	WI
Zip	:	53185-2907
Country	:	US
Telephone Number	:	262-534-7297
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHRISTOPHER SLOVER
Credential	:
Telephone Number	:	512-973-9700

Provider Enumeration Date	:	01/16/2008
Last Update Date	:	11/24/2008

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