Provider Demographics
NPI:1427054048
Name:LAKEVIEW VILLAGE, INC
Entity type:Organization
Organization Name:LAKEVIEW VILLAGE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:I
Authorized Official - Last Name:CLAUSEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPA
Authorized Official - Phone:913-744-2470
Mailing Address - Street 1:9100 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-3353
Mailing Address - Country:US
Mailing Address - Phone:913-888-1900
Mailing Address - Fax:913-888-4141
Practice Address - Street 1:13840 W 91ST TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3299
Practice Address - Country:US
Practice Address - Phone:913-888-1900
Practice Address - Fax:913-888-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN046007314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1042147001Medicaid
KSMS-2004OtherEDS
175242Medicare Oscar/Certification