Lakewood Senior Living of Alta Vista LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

115822 Issued in TX

Legal business name

LAKEWOOD SENIOR LIVING OF ALTA VISTA LLC

Doing business as

Lakewood Senior Living of Alta Vista

Practice address

616 W Russell PL
San Antonio, TX 78212-3658

Phone

(210) 735-9233

Fax

(210) 735-0164

NPI assigned

Sep 20, 2006

Last updated

Apr 28, 2010By 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

Ms. April M Puccetti

Title

Administrator

Phone

(205) 320-7507

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lakewood Senior Living of Alta Vista Doing business as

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272412800000",
    "number": "1265530430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 W RUSSELL PL",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782123658",
            "telephone_number": "210-735-9233",
            "fax_number": "210-735-0164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 W RUSSELL PL",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782123658",
            "telephone_number": "210-735-9233",
            "fax_number": "210-735-0164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD SENIOR LIVING OF ALTA VISTA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2010-04-28",
        "status": "A",
        "authorized_official_last_name": "PUCCETTI",
        "authorized_official_first_name": "APRIL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "205-320-7507",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "115822",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001013791",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakewood Senior Living of Alta Vista",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2010; 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.