LAKE DRIVE HEALTH CARE LLC NPI 1598002966

NPI Information

NPI: 1598002966
Provider Name: LAKE DRIVE HEALTH CARE LLC

Doing Business As: LAKE DRIVE CARE AND REHABILITATION CENTER

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization

Address:
600 LAKE RD
HENRYETTA, OK
ZIP 74437
Phone: (918) 652-8101
Get Directions

LAKE DRIVE HEALTH CARE LLC is an intermediate care facility mentally retarded in Henryetta, OK. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. LAKE DRIVE HEALTH CARE LLC NPI is 1598002966. The provider is registered as an organization entity type.
The provider Is Doing Business As Lake Drive Care And Rehabilitation Center.

The provider's business location address is:

600 LAKE RD
HENRYETTA, OK
ZIP 74437-415
Phone: (918) 652-8101
Fax: (918) 652-0253

The provider's authorized official is Judah Bienstock .
The authorized official title is Managing Member and has the following contact phone number (314) 812-2550.

The CLIA number assigned to this NPI record is 37D0656737 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/5/2013 and was last updated on 12/2/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		NH5605	OKLAHOMA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100779100A	MEDICAID	OKLAHOMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »