Provider Demographics
NPI:1891384558
Name:LAKESHORE MANOR NURSING AND REHAB LLC
Entity type:Organization
Organization Name:LAKESHORE MANOR NURSING AND REHAB LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-359-5401
Mailing Address - Street 1:10401 LINN STATION RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3825
Mailing Address - Country:US
Mailing Address - Phone:270-336-1050
Mailing Address - Fax:
Practice Address - Street 1:1400 LINDBERG DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8056
Practice Address - Country:US
Practice Address - Phone:985-641-4985
Practice Address - Fax:985-646-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility