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	5803	OH
2	313M00000X	Nursing Facility/Intermediate Care Facility	4943	OH
3	314000000X	Skilled Nursing Facility	4943	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1699771089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWOOD HEALTH CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	13315 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	:	13315 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	:	PRESIDENT
Name	:	MRS. PATRICE M. CAMPBELL
Credential	:	LNHA
Telephone Number	:	216-226-3858

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/26/2019

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Directions to “LAKEWOOD HEALTH CARE CENTER, INC. ” Practice Location

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