Provider Demographics
NPI:1427473867
Name:LAKEWOOD HEALTH CARE AGENCY INC
Entity type:Organization
Organization Name:LAKEWOOD HEALTH CARE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YONAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUCKLES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-201-4503
Mailing Address - Street 1:1918 SANTA ANNA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-5611
Mailing Address - Country:US
Mailing Address - Phone:817-201-4503
Mailing Address - Fax:817-642-5314
Practice Address - Street 1:1918 SANTA ANNA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-5611
Practice Address - Country:US
Practice Address - Phone:817-201-4503
Practice Address - Fax:817-642-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health