Organization
LAKEBRIDGE MEDICAL INVESTORS, LLC
Active
Other names
lakebridge health care center
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY (J.R.) R LEWIS (CHIEF MANAGER)
(423) 975-5455
Entity
Organization
Contact information
Practice address
115 WOODLAWN DR, JOHNSON CITY, TN 37604-5978
(423) 975-0095
(423) 928-0358
Mailing address
115 WOODLAWN DR, JOHNSON CITY, TN 37604-5978
(423) 975-0095
(423) 928-0358
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
0000000340
TN
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0445358
—
TN
05
—
7440576
—
TN
Enumeration date
11/01/2006
Last updated
06/12/2008
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