# LAKEWOOD SENIOR LIVING OF ALTA VISTA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lakewood Senior Living of Alta Vista
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265530430
- **Authorized official:** MS. APRIL M PUCCETTI (ADMINISTRATOR)
- **Authorized official phone:** (205) 320-7507

## Contact information

- **Practice address:** 616 W RUSSELL PL, SAN ANTONIO, TX 78212-3658
- **Practice address phone:** (210) 735-9233
- **Practice address fax:** (210) 735-0164
- **Mailing address:** 616 W RUSSELL PL, SAN ANTONIO, TX 78212-3658
- **Mailing address phone:** (210) 735-9233
- **Mailing address fax:** (210) 735-0164

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 115822 | TX | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 04/28/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001013791 | — | TX |