MEDICARE: LAKEVIEW METHODIST HEALTH CARE CENTER

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	314000000X	Skilled Nursing Facility	245280	MN

General Provider Information

NPI Number	:	1831191147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEVIEW METHODIST HEALTH CARE CENTER

Provider Business Mailing Address
First Line	:	610 SUMMIT DR
Second Line	:
City	:	FAIRMONT
State	:	MN
Zip	:	56031-2247
Country	:	US
Telephone Number	:	507-235-6606
Fax Number	:	507-235-6767

Provider Business Practice Location Address
First Line	:	610 SUMMIT DR
Second Line	:
City	:	FAIRMONT
State	:	MN
Zip	:	56031-2247
Country	:	US
Telephone Number	:	507-235-6606
Fax Number	:	507-235-6767

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ROBERT S LAKE
Credential	:
Telephone Number	:	507-235-6606

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/22/2020

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