CCN: 675993 NPI: 1437452778 Organization

LAKE ARTHUR PLACE

4225 LAKE ARTHUR DR
PORT ARTHUR, TX 776426490

Contact Information

Phone 4097273193
Fax 4097274777
Enumeration Date 2010-12-08
Last Updated 2020-03-04

Taxonomies

Code: 313M00000X (Primary) License State: TX License: 138973

Inpatient Payment Attributes (IPSF) View Dictionary →

Effective Date:

censusDivision 7

cbsaActualGeographicLocation 13140

providerType 38

caseMixIndex 1.0

Outpatient Payment Attributes (OPSF) View Dictionary →

Effective Date:

cbsaActualGeographicLocation 13140

providerType 38

specialPaymentIndicator

carrierCode 04412

localityCode 20