| NPI | 1275556383 |
|---|---|
| Doing Business As | LAKESIDE PAVILION |
| Entity Type | Organization |
| Authorized Contact | MICHAEL TENNESSEE BERG Assistant Secretary 505-468-4742 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: FL SNF 12840962) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2016-01-04 |