1821118340 NPI number — LAKEVIEW NEUROREHAB CENTER MIDWEST, INC

Table of content: (NPI 1821118340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821118340 NPI number — LAKEVIEW NEUROREHAB CENTER MIDWEST, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKEVIEW NEUROREHAB CENTER MIDWEST, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821118340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 SHARP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53185-5214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-534-7297
Provider Business Mailing Address Fax Number:
262-534-8540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 SHARP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53185-5214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-534-7297
Provider Business Practice Location Address Fax Number:
262-534-8540
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SLOVER
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
512-973-9700

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  8222-042 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11022100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com