Provider Demographics
NPI:1982936043
Name:LAKE POINTE REHABILITATION AND HEALTH CARE.LLC
Entity type:Organization
Organization Name:LAKE POINTE REHABILITATION AND HEALTH CARE.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAILY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-593-6266
Mailing Address - Street 1:22 PARRISH RD
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-1178
Mailing Address - Country:US
Mailing Address - Phone:440-593-6266
Mailing Address - Fax:440-593-6203
Practice Address - Street 1:22 PARRISH RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-1178
Practice Address - Country:US
Practice Address - Phone:440-593-6266
Practice Address - Fax:440-593-6203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH313M00000N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH365441Medicare UPIN