1730826066 NPI number — LAKEWOOD THERAPY AND LIVING CENTER OPCO LLC

Table of content: (NPI 1730826066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730826066 NPI number — LAKEWOOD THERAPY AND LIVING CENTER OPCO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKEWOOD THERAPY AND LIVING CENTER OPCO LLC
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:
1730826066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEARCY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72145-8250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-254-0007
Provider Business Mailing Address Fax Number:
888-866-9887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 LAKEPARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71901-9260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-262-1920
Provider Business Practice Location Address Fax Number:
501-262-5237
Provider Enumeration Date:
05/18/2022

Additional Information

Authorized Official

Authorized Official Last Name:
DREIFUS
Authorized Official First Name:
ETHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED SIGNATORY
Authorized Official Telephone Number:
501-961-8100

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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