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Organization
LAKE DRIVE HEALTH CARE LLC
Active
Organization
LAKE DRIVE HEALTH CARE LLC
Active
Other names
Lake Drive Care and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
JUDAH BIENSTOCK (MANAGING MEMBER)
(314) 812-2550
Entity
Organization
Contact information
Practice address
600 LAKE RD, HENRYETTA, OK 74437-5415
(918) 652-8101
(918) 652-0253
Mailing address
600 LAKE RD, HENRYETTA, OK 74437-5415
(918) 652-8101
(918) 652-0253
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
NH5605
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100779100A
—
OK
Enumeration date
01/05/2013
Last updated
12/02/2015
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