Lakewood Nursing Center Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LAKEWOOD NURSING CENTER INC

Practice address

100 N Lake St
Crescent City, FL 32112-2620

Phone

(386) 698-2222

Fax

(386) 698-2717

NPI assigned

Aug 10, 2005

Organization subpart

No

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

Authorized official

Name

Robert W Hagan

Title

President

Phone

(770) 993-4000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Putnam Council on Aging, Inc. Former legal business name

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563408000000",
    "number": "1972505949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N LAKE ST",
            "city": "CRESCENT CITY",
            "state": "FL",
            "postal_code": "321122620",
            "telephone_number": "386-698-2222",
            "fax_number": "386-698-2717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N LAKE ST",
            "city": "CRESCENT CITY",
            "state": "FL",
            "postal_code": "321122620",
            "telephone_number": "386-698-2222",
            "fax_number": "386-698-2717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD NURSING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-10",
        "last_updated": "2019-07-18",
        "status": "A",
        "authorized_official_last_name": "HAGAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-993-4000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031214200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Putnam Council on Aging, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Putnam Council on Aging, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• John F Hull DO PA
• Charlene Judge, LMT
• Lydia Kite
• Daniel S Kreisman, P.A.
• Lake Area Physical Therapy Crescent City, Inc
• Lakewood Operations LLC (Lakewood Nursing and Rehabilitation Center)
• Paul Lee, DMD
• Marcia Marie Long
• Diwata Enriquez Lopez, PT
• Roger Alan Lowe, DDS

• Skilled Nursing Facility in Crescent City, FL
• Providers in Crescent City, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; 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.