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NPI Code Detail

MEDICARE: LAKESIDE BEIKIRCH CARE CENTER, INC.

MEDICARE: LAKESIDE BEIKIRCH 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
1261QH0700XHearing and Speech Clinic/Center2752301NNY
2314000000XSkilled Nursing Facility2752301NNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1106288CIOTHERNYPREFERRED CARE
2CNOTHERNYEXCELLUS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891791927
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKESIDE BEIKIRCH CARE CENTER, INC.
Provider Business Mailing Address
First Line : 170 WEST AVE
Second Line :
City : BROCKPORT
State : NY
Zip : 14420-1227
Country : US
Telephone Number : 585-395-6052
Fax Number : 585-395-6007
Provider Business Practice Location Address
First Line : 170 WEST AVE
Second Line :
City : BROCKPORT
State : NY
Zip : 14420-1227
Country : US
Telephone Number : 585-395-6052
Fax Number : 585-395-6007
Authorized Official
Title or Position : ADMINISTRATOR
Name : KIMBERLY KLINETOB
Credential :
Telephone Number : 585-395-6095
Provider Enumeration Date : 06/23/2005
Last Update Date : 09/03/2015

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Directions to “LAKESIDE BEIKIRCH CARE CENTER, INC. ” Practice Location

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