Provider Demographics
NPI:1801811609
Name:LAKEWOOD HEALTHCARE, INC.
Entity type:Organization
Organization Name:LAKEWOOD HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, LNHA
Authorized Official - Phone:501-262-1920
Mailing Address - Street 1:260 LAKEPARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901
Mailing Address - Country:US
Mailing Address - Phone:501-262-1920
Mailing Address - Fax:501-262-5237
Practice Address - Street 1:260 LAKEPARK DRIVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901
Practice Address - Country:US
Practice Address - Phone:501-262-1920
Practice Address - Fax:501-262-5237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR024314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR109481311Medicaid
AR15404OtherMEDI-PAK
AR109481311Medicaid