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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