MEDICARE: LAKE VIEW TERRACE MANAGEMENT LLC

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	3104A0630X	Assisted Living Facility (Behavioral Disturbances)

General Provider Information

NPI Number	:	1770422149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE VIEW TERRACE MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	13455 KNAUS RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-2161
Country	:	US
Telephone Number	:	928-855-8099
Fax Number	:	928-855-6666

Provider Business Practice Location Address
First Line	:	320 LAKE HAVASU AVE N
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-4701
Country	:	US
Telephone Number	:	928-855-8099
Fax Number	:	928-855-6666

Authorized Official
Title or Position	:	CEO
Name	:	TARA KILLINGER-WELLE
Credential	:
Telephone Number	:	971-533-0851

Provider Enumeration Date	:	03/27/2026
Last Update Date	:	03/27/2026

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