Provider Demographics
NPI:1386162501
Name:LAKEWOOD OAKS, LLC
Entity type:Organization
Organization Name:LAKEWOOD OAKS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-418-2900
Mailing Address - Street 1:1192 S. DRAPER PARKWAY
Mailing Address - Street 2:SUITE 242
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020
Mailing Address - Country:US
Mailing Address - Phone:206-418-2900
Mailing Address - Fax:
Practice Address - Street 1:11411 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3047
Practice Address - Country:US
Practice Address - Phone:253-581-9002
Practice Address - Fax:253-581-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility