Millville Leasing Partnership

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

290902 Issued in PA

Legal business name

MILLVILLE LEASING PARTNERSHIP

Doing business as

Lakeside Nursing Center

Practice address

357 Old Lake Rd
Dallas, PA 18612

Phone

(570) 639-1885

Fax

(570) 639-5163

NPI assigned

Oct 13, 2005

Last updated

Nov 11, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Francis A Hayman Jr.

Title

President Lehigh Nursing Corp

Phone

(610) 264-8000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lakeside Nursing Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226361600000",
    "number": "1033107073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "357 OLD LAKE RD",
            "city": "DALLAS",
            "state": "PA",
            "postal_code": "18612",
            "telephone_number": "570-639-1885",
            "fax_number": "570-639-5163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 OLD LAKE RD",
            "city": "DALLAS",
            "state": "PA",
            "postal_code": "18612",
            "telephone_number": "570-639-1885",
            "fax_number": "570-639-5163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLVILLE LEASING PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-13",
        "last_updated": "2008-11-11",
        "status": "A",
        "authorized_official_last_name": "HAYMAN",
        "authorized_official_first_name": "FRANCIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT LEHIGH NURSING CORP",
        "authorized_official_telephone_number": "610-264-8000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "PA",
            "license": "290902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007557700003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Dallas, PA
• Providers in Dallas, PA by specialty
• Skilled Nursing Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.