West Lake Healthcare Residence Operator LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

WEST LAKE HEALTHCARE RESIDENCE OPERATOR LLC

Practice address

825 W. Kearney
Mesquite, TX 75149-3206

Phone

(972) 288-7688

NPI assigned

Aug 19, 2015

Last updated

Mar 30, 2018By 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

Josef Neuman

Title

Manager

Phone

(214) 396-3462

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1439942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522368000000",
    "number": "1063888535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 CLIFTON AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013342",
            "telephone_number": "214-396-3462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 W. KEARNEY",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751493206",
            "telephone_number": "972-288-7688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST LAKE HEALTHCARE RESIDENCE OPERATOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-19",
        "last_updated": "2018-03-30",
        "status": "A",
        "authorized_official_last_name": "NEUMAN",
        "authorized_official_first_name": "JOSEF",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "214-396-3462"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DADS",
            "identifier": "005142",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001027232",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2018; 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.