| NPI | 1598002966 |
|---|---|
| Doing Business As | LAKE DRIVE CARE AND REHABILITATION CENTER |
| Entity Type | Organization |
| Authorized Contact | JUDAH BIENSTOCK Managing Member 314-812-2550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: OK NH5605) |
| Enumeration Date | 2013-01-05 |
| Last Update Date | 2015-12-02 |