# LAKESIDE SENIOR CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lakeside Rehabilitation and Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902040223
- **Authorized official:** KERI POWELL (PRESIDENT)
- **Authorized official phone:** (806) 793-2555

## Contact information

- **Practice address:** 4306 24TH ST, LUBBOCK, TX 79410-1818
- **Practice address phone:** (806) 793-2555
- **Mailing address:** 930 RIDGEBROOK RD, SPARKS, MD 21152-9390

## Taxonomy

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

## Other

- **Enumeration date:** 04/30/2009
- **Last updated:** 04/30/2009