Lakeside Beikirch Care Center, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2752301N Issued in NY

Legal business name

LAKESIDE BEIKIRCH CARE CENTER, INC.

Practice address

170 West Ave
Brockport, NY 14420-1227

Phone

(585) 395-6052

Fax

(585) 395-6007

NPI assigned

Jun 23, 2005

Last updated

Sep 3, 2015By 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

Kimberly Klinetob

Title

Administrator

Phone

(585) 395-6095

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441238400000",
    "number": "1891791927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 WEST AVE",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201227",
            "telephone_number": "585-395-6052",
            "fax_number": "585-395-6007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 WEST AVE",
            "city": "BROCKPORT",
            "state": "NY",
            "postal_code": "144201227",
            "telephone_number": "585-395-6052",
            "fax_number": "585-395-6007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE BEIKIRCH CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2015-09-03",
        "status": "A",
        "authorized_official_last_name": "KLINETOB",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "585-395-6095"
    },
    "taxonomies": [
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "NY",
            "license": "2752301N",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "2752301N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "106288CI",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01137113",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS",
            "identifier": "CN",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole L Knickerbocker, LPN
• Matthew Kovaleski, PT, DPT
• Adam Krahmer, D.P.T.
• Lakeshore Surgical Practice, PC
• Lakeside Anesthesia PLLC
• Lakeside Health System
• Lakeside Health System Medical Services
• Lakeside Hospital Internal Medicine Group
• Lakeside Imaging, LLC
• Lakeside Memorial Hospital Inc (Lakeside Memorial Hosp Phcy Inc)

• Skilled Nursing Facility in Brockport, NY
• Providers in Brockport, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2015; 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.