# LAKEVIEW LUTHERAN MANOR

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LUTHERAN SOCIAL SERVICES OF MICHIGAN
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1407849656
- **Legal business name:** LUTHERAN SOCIAL SERVICES OF MICHIGAN
- **Authorized official:** DAVID GOODRICH (ADMINISTRATOR)
- **Authorized official phone:** (231) 775-0101

## Contact information

- **Practice address:** 460 PEARL ST, CADILLAC, MI 49601-2620
- **Practice address phone:** (231) 775-0101
- **Practice address fax:** (231) 775-1390
- **Mailing address:** 460 PEARL ST, CADILLAC, MI 49601-2620
- **Mailing address phone:** (231) 775-0101
- **Mailing address fax:** (231) 775-1390

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 844020 | MI | Yes |

## Other

- **Enumeration date:** 08/23/2005
- **Last updated:** 02/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 09537 | BCBS | MI |
| 05 | — | 1796149 | — | MI |