Southlake Tricity Rba

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

Legal business name

SOUTHLAKE TRICITY RBA

Doing business as

Lake Park Residential Care

Practice address

2075 Ripley St
Lake Station, IN 46405-1161

Phone

(219) 962-9437

NPI assigned

Mar 16, 2007

Last updated

Aug 22, 2020By 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

Robert D Krumwied, MHA

Title

Ceo

Phone

(219) 392-6010

Specialties & licenses 1

Addresses

Other names 1

• Lake Park Residential Care Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972637171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2075 RIPLEY ST",
            "city": "LAKE STATION",
            "state": "IN",
            "postal_code": "464051161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2075 RIPLEY ST",
            "city": "LAKE STATION",
            "state": "IN",
            "postal_code": "464051161",
            "telephone_number": "219-962-9437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE TRICITY RBA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KRUMWIED",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "219-392-6010",
        "authorized_official_credential": "MHA"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Park Residential Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Custodial Care Facility in Lake Station, IN
• Providers in Lake Station, IN by specialty
• Custodial Care Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.