Provider Demographics
NPI:1063976926
Name:LAKEVIEW OF KIRKLAND
Entity type:Organization
Organization Name:LAKEVIEW OF KIRKLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-803-6911
Mailing Address - Street 1:6505 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6953
Mailing Address - Country:US
Mailing Address - Phone:425-803-6911
Mailing Address - Fax:
Practice Address - Street 1:6505 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6953
Practice Address - Country:US
Practice Address - Phone:425-803-6911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLTOWER PEGASUS TENANT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2482Medicaid