| NPI | 1700193133 |
|---|---|
| Doing Business As | LAKE VILLAGE REHABILIATION AND CARE CENTER |
| Entity Type | Organization |
| Authorized Contact | ROSS PONTHIE Member 318-443-8167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2020-07-13 |