Lake Country Healthcare LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

365591 Issued in OK

Legal business name

LAKE COUNTRY HEALTHCARE LLC

Doing business as

Lake Country Healthcare LLC

Practice address

27753 S Welling Rd
Welling, OK 74471-2202

Phone

(918) 457-9997

Fax

(918) 457-5096

NPI assigned

Jul 30, 2006

Last updated

Dec 16, 2011By 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

Marsena McIntosh

Title

Manager

Phone

(918) 457-5535

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• LAKE COUNTRY HEALTHCARE LLC Doing business as

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323993600000",
    "number": "1942215561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27753 S WELLING RD",
            "city": "WELLING",
            "state": "OK",
            "postal_code": "744712202",
            "telephone_number": "918-457-9997",
            "fax_number": "918-457-5096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27753 S WELLING RD",
            "city": "WELLING",
            "state": "OK",
            "postal_code": "744712202",
            "telephone_number": "918-457-9997",
            "fax_number": "918-457-5096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTRY HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2011-12-16",
        "status": "A",
        "authorized_official_last_name": "MCINTOSH",
        "authorized_official_first_name": "MARSENA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "918-457-5535"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "OK",
            "license": "365591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3723625",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200008180A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LAKE COUNTRY HEALTHCARE LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brandon Kirk Hembree
• Melissa Kelley
• Sarah Nicole Kelley, BSW
• Autumn Ketcher
• Anita Sue Kilgore
• Lake Francis Residential Care Home, LLC
• Lake Francis Residential Care LLC
• Chelsea Allece Lechner
• Jason Ray Lechner, MS LPC-C
• Susan Dean Littlejohn, BA

• Long Term Care Pharmacy in Welling, OK
• Providers in Welling, OK by specialty
• Long Term Care Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2011; 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.