# WEST LAKE HEALTHCARE RESIDENCE OPERATOR LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063888535
- **Authorized official:** JOSEF NEUMAN (MANAGER)
- **Authorized official phone:** (214) 396-3462

## Contact information

- **Practice address:** 825 W. KEARNEY, MESQUITE, TX 75149-3206
- **Practice address phone:** (972) 288-7688
- **Mailing address:** 111 CLIFTON AVE, LAKEWOOD, NJ 08701-3342
- **Mailing address phone:** (214) 396-3462

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | TX | Yes |

## Other

- **Enumeration date:** 08/19/2015
- **Last updated:** 03/30/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001027232 | — | TX |
| 01 | — | 005142 | DADS | TX |