LAKEWOOD SENIOR CAMPUS, LLC (NPI# 1114935392) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114935392 |
| Entity Type | Organization |
| Organization Name | LAKEWOOD SENIOR CAMPUS, LLC |
| Other Organization Name | LAKEWOOD SENIOR HEALTH CAMPUS |
| Practice Address |
13900 Detroit Ave Lakewood OH 44107-4624 |
| Mailing Address |
34100 Center Ridge Rd Suite 10 North Ridgeville OH 44039-5311 |
| Practice Telephone | 4402287650 |
| Practice Fax Number | 4402287655 |
| Mailing Telephone | 4403279777 |
| Mailing Fax Number | 4403276172 |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2007-11-14 |
| Authorized Official Name | MR. JOHN T. O'NEILL (PRESIDENT) |
| Authorized Official Telephone | 4403270110 |
| Authorized Official Credential | LNHA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 4204 | OH | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | STATE OF OHIO NURSING HOM | 4204 | 01 |
| Other Name | Type Code |
|---|---|
| Lakewood Senior Health Campus | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | LAKEWOOD SENIOR CAMPUS, LLC | 13900 Detroit Ave, Lakewood, OH 44107-4624 |
| Street Address |
13900 DETROIT AVE |
| City | LAKEWOOD |
| State | OH |
| Zip Code | 44107-4624 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679096630 | Amber Brooke Hyland | Nurse Practitioner | 13900 Detroit Ave, Lakewood, OH 44107-4624 | 2017-07-21 |
| 1194066118 | Jodi Leann Parker | Licensed Practical Nurse | 13900 Detroit Ave, Lakewood Senior Health Campus, Lakewood, OH 44107-4624 | 2013-03-15 |
| 1497029946 | Ohio Renal Care Group LLC | Clinic/Center | 13900 Detroit Ave, Lakewood, OH 44107-4624 | 2012-03-01 |
| 1275787798 | Lakewood Senior Health Campus | Clinical Medical Laboratory | 13900 Detroit Ave, Lakewood, OH 44107-4624 | 2008-11-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326522210 | Lawrence M Roth | Social Worker | 14701 Detroit Ave Ste 363, Lakewood, OH 44107 | 2018-09-18 |
| 1376065730 | Fareeha Khan | Internal Medicine | 12540 Edgewater Drive, Apt 411, Lakewood, OH 44107 | 2017-07-07 |
| 1912433756 | Julie Ann Foucher-urcuyo | Family Medicine | 14601 Detroit Ave, Fl 2, Lakewood, OH 44107 | 2017-05-11 |
| 1225563661 | Elizabeth Ann Rainbolt | Family Medicine | 14601 Detroit Ave Fl 2, Lakewood, OH 44107 | 2017-04-24 |
| 1255882551 | Kristen Murray | Dietitian, Registered | 14900 Detroit Ave Ste 207, Lakewood, OH 44107 | 2016-10-21 |
| 1265828131 | David Thomas Jonke | Dentist | 15640 Madison Ave., Lakewood, OH 44107 | 2015-04-08 |
| 1760885941 | Debra Watkins | Home Health Aide | 1510 Newman Ave Apt 406, Lakewood, OH 44107 | 2014-10-02 |
| 1396155198 | Monica M Owen | Occupational Therapist | 9200 Biddulph Rd., Brooklyn, OH 44107 | 2014-05-01 |
| 1730512229 | Marsha Elaine Favors | Licensed Practical Nurse | 1448 Lakeland Ave, Lakewood, OH 44107 | 2013-08-20 |
| 1508130006 | Ruth Rachel Raciniewski | Counselor | 15200 Madison Avenue, Lakewood, OH 44107 | 2012-03-01 |
| Find all providers in zip 44107 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
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| 1720520729 | Meghan Ricketson | Skilled Nursing Facility | 5962 W Pacific Cir, Lakewood, CO 80227-2583 | 2016-11-08 |
| 1932564994 | Loveland Elder Green House Homes for Life Enhancement | Skilled Nursing Facility | 12136 W Bayaud Ave Ste 200, Lakewood, CO 80228-2115 | 2015-12-17 |
| 1598176828 | Loveland Elder Green House Homes for Life Enrichment A Colorado Non | Skilled Nursing Facility | 12136 W Bayaud Ave, Suite 200, Lakewood, CO 80228-2115 | 2014-05-08 |
| 1588089676 | 7395 W Eastman Place Operations LLC | Skilled Nursing Facility | 7395 W. Eastman Place, Lakewood, CO 80227-1234 | 2014-02-26 |
| 1275855058 | Azura of Lakewood, LLC | Skilled Nursing Facility | 7395 West Eastman Place, Lakewood, CO 80227-5039 | 2010-02-22 |
| 1922147784 | W IIi, Inc. | Skilled Nursing Facility | 1655 Eaton St, Lakewood, CO 80214-1628 | 2007-02-06 |
| 1750431912 | Mile High Care Services LLC | Skilled Nursing Facility | 115 Ingalls St, Lakewood, CO 80226-1815 | 2007-01-11 |
| Find all providers in LAKEWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.