Provider Demographics
NPI:1124095534
Name:LAKESIDE TERRACE
Entity type:Organization
Organization Name:LAKESIDE TERRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:J
Authorized Official - Last Name:STRAHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-284-3471
Mailing Address - Street 1:511 PARAMOUNT ST
Mailing Address - Street 2:
Mailing Address - City:SABETHA
Mailing Address - State:KS
Mailing Address - Zip Code:66534
Mailing Address - Country:US
Mailing Address - Phone:785-284-3471
Mailing Address - Fax:785-284-3697
Practice Address - Street 1:1100 HARRISON
Practice Address - Street 2:
Practice Address - City:SABETHA
Practice Address - State:KS
Practice Address - Zip Code:66534
Practice Address - Country:US
Practice Address - Phone:785-284-3471
Practice Address - Fax:785-284-3697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN066007315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities