1487644464 NPI number — LAKEVIEW CHRISTIAN HOME OF THE SOUTHWEST, INC.

Table of content: (NPI 1487644464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487644464 NPI number — LAKEVIEW CHRISTIAN HOME OF THE SOUTHWEST, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKEVIEW CHRISTIAN HOME OF THE SOUTHWEST, 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:
Provider Other Organization Name Type Code:
6
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:
1487644464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1905 W PIERCE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88220-4025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-887-3947
Provider Business Mailing Address Fax Number:
505-234-1905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 N CANAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88220-4600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-887-3947
Provider Business Practice Location Address Fax Number:
505-234-1905
Provider Enumeration Date:
10/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KNOX
Authorized Official First Name:
JOANNA
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
C.E.O.
Authorized Official Telephone Number:
505-887-3947

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  6567 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X , with the licence number: 5088 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X , with the licence number: 5553 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 5088 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , with the licence number: 3000 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: B5046 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: I0381 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: N3177 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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