LAKE DRIVE HOME
NPI 1851346142
Intermediate Care Facility, Intellectual Disabilities in Henryetta, OK

Q: What is Peak Medical Oklahoma No. 12, Inc.'s NPI number?

The NPI number for Peak Medical Oklahoma No. 12, Inc. is 1851346142. It was assigned to this organization in the NPPES registry on May 24, 2006. The provider is doing business as Lake Drive Home.

Q: What is Peak Medical Oklahoma No. 12, Inc.'s specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

Active since May 24, 2006

600 LAKE RD, HENRYETTA, OK 74437(918) 652-8101(918) 652-8209 Get Directions Write a Review

NPPES record last updated: September 28, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Lake Drive Home NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE DRIVE HOME (NPI 1851346142) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Henryetta, Oklahoma and active in the NPI registry since May 2006. The organization lists William A. Mathies, President Director, as its authorized official.

NPPES Registry Identity

NPI1851346142

Entity TypeOrganization

Primary Taxonomy315P00000X

Legal Business NamePEAK MEDICAL OKLAHOMA NO. 12, INC.

Location Address600 LAKE RDHenryetta, OK 74437-5415

Mailing Address101 Sun Ave Ne, Compliance DepartmentAlbuquerque, NM 87109-4373 · (505) 821-3355

Phone(918) 652-8101

Fax(918) 652-8209

Organization SubpartYesParent: Sunbridge Healthcare Corporation

Authorized OfficialWilliam A. MathiesPresident Director · (505) 821-3355

Enumeration DateMay 24, 2006

Last NPPES UpdateSeptember 28, 2009

✔ NPI 1851346142 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities

Taxonomy Code315P00000X

License✔ Licensed in OK · NH56055605

Definition

An intermediate care facility providing services for individuals with intellectual disabilities.

600 LAKE RD, Henryetta, OK 74437

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Other Names 1

Doing Business AsLake Drive Home

Other Identifiers 1

Medicaid100779100AOK

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAKE DRIVE HEALTH CARE LLC

Intermediate Care Facility, Intellectual Disabilities

600 LAKE RD
HENRYETTA, OK 74437

Okmulgee County (918) 652-8101

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Peak Medical Oklahoma No. 12, Inc.'s NPI number?

The NPI number for Peak Medical Oklahoma No. 12, Inc. is 1851346142. It was assigned to this organization in the NPPES registry on May 24, 2006. The provider is doing business as Lake Drive Home.

Where is Peak Medical Oklahoma No. 12, Inc. located?

Peak Medical Oklahoma No. 12, Inc. is located at 600 Lake Rd, Henryetta, OK 74437. The listed phone number is (918) 652-8101.

What is Peak Medical Oklahoma No. 12, Inc.'s specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

When was this NPI record last updated?

The NPPES record for Peak Medical Oklahoma No. 12, Inc. was last updated on September 28, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.