# LAKESIDE MOUNTAIN MANOR LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932391893
- **Authorized official:** MRS. DEBRA JEAN DROLL (MEMBER)
- **Authorized official phone:** (417) 546-5595

## Contact information

- **Practice address:** 238 HARMONY HTS, FORSYTH, MO 65653-5533
- **Practice address phone:** (417) 546-5595
- **Practice address fax:** (417) 546-2829
- **Mailing address:** 238 HARMONY HTS, FORSYTH, MO 65653-5533
- **Mailing address phone:** (417) 546-5595
- **Mailing address fax:** (417) 546-2829

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 034594 | MO | Yes |

## Other

- **Enumeration date:** 08/15/2007
- **Last updated:** 08/15/2007