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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 Facility04-000032-01IN

General Provider Information

NPI Number : 1710973664
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKEVIEW MANOR, INC.
Provider Business Mailing Address
First Line : 45 BEACHWAY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46224-8501
Country : US
Telephone Number : 317-243-3721
Fax Number : 317-240-4357
Provider Business Practice Location Address
First Line : 45 BEACHWAY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46224-8501
Country : US
Telephone Number : 317-243-3721
Fax Number : 317-240-4357
Authorized Official
Title or Position : PRESIDENT
Name : MR. TIMOTHY DEAN PAINO
Credential :
Telephone Number : 317-243-3721
Provider Enumeration Date : 09/26/2005
Last Update Date : 08/22/2020

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Directions to “LAKEVIEW MANOR, INC. ” Practice Location

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