# LAKEBRIDGE MEDICAL INVESTORS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** lakebridge health care center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407933443
- **Authorized official:** JIMMY (J.R.) R LEWIS (CHIEF MANAGER)
- **Authorized official phone:** (423) 975-5455

## Contact information

- **Practice address:** 115 WOODLAWN DR, JOHNSON CITY, TN 37604-5978
- **Practice address phone:** (423) 975-0095
- **Practice address fax:** (423) 928-0358
- **Mailing address:** 115 WOODLAWN DR, JOHNSON CITY, TN 37604-5978
- **Mailing address phone:** (423) 975-0095
- **Mailing address fax:** (423) 928-0358

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 0000000340 | TN | — |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/01/2006
- **Last updated:** 06/12/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0445358 | — | TN |
| 05 | — | 7440576 | — | TN |