| NPI | 1851346142 |
|---|---|
| Doing Business As | LAKE DRIVE HOME |
| Entity Type | Organization |
| Authorized Contact | WILLIAM A. MATHIES President Director 505-821-3355 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: OK NH56055605) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2009-09-28 |