1396726873 NPI number — LAKEVIEW NEUROREHAB CENTER MIDWEST, INC

Table of content: (NPI 1396726873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396726873 NPI number — LAKEVIEW NEUROREHAB CENTER MIDWEST, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKEVIEW NEUROREHAB CENTER MIDWEST, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAKEVIEW SPECIALTY HOSPITAL AND REHAB
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396726873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 SHARP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53185-5214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-534-7297
Provider Business Mailing Address Fax Number:
262-534-7257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 SHARP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53185-5214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-534-7297
Provider Business Practice Location Address Fax Number:
262-534-7257
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SLOVER
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
511-773-8076

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11022100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11022181 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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