Provider Demographics
NPI:1780775668
Name:LAKEVIEW HOME CARE INC
Entity type:Organization
Organization Name:LAKEVIEW HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR / CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUENTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-547-5501
Mailing Address - Street 1:307 EAST SAN PATRICIO
Mailing Address - Street 2:
Mailing Address - City:MATHIS
Mailing Address - State:TX
Mailing Address - Zip Code:78368
Mailing Address - Country:US
Mailing Address - Phone:361-547-5501
Mailing Address - Fax:361-547-3688
Practice Address - Street 1:307 EAST SAN PATRICIO
Practice Address - Street 2:
Practice Address - City:MATHIS
Practice Address - State:TX
Practice Address - Zip Code:78368
Practice Address - Country:US
Practice Address - Phone:361-547-5501
Practice Address - Fax:361-547-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003523251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX024157201Medicaid
TX458490Medicare Oscar/Certification
TX024157201Medicaid