Provider Demographics
NPI:1053726828
Name:KENMARE LAKEVIEW LLC
Entity type:Organization
Organization Name:KENMARE LAKEVIEW LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-385-4941
Mailing Address - Street 1:315 2ND AVE NW
Mailing Address - Street 2:BOX 787
Mailing Address - City:KENMARE
Mailing Address - State:ND
Mailing Address - Zip Code:58746-7160
Mailing Address - Country:US
Mailing Address - Phone:701-385-4941
Mailing Address - Fax:701-385-4215
Practice Address - Street 1:315 2ND AVE NW
Practice Address - Street 2:BOX 787
Practice Address - City:KENMARE
Practice Address - State:ND
Practice Address - Zip Code:58746-7160
Practice Address - Country:US
Practice Address - Phone:701-385-4941
Practice Address - Fax:701-385-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8092311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND=========Medicaid