LAKE PARK RESIDENTIAL CARE
NPI 1972637171
Custodial Care Facility in Lake Station, IN

Q: What is Southlake Tricity Rba's NPI number?

The NPI number for Southlake Tricity Rba is 1972637171. It was assigned to this organization in the NPPES registry on March 16, 2007. The provider is doing business as Lake Park Residential Care.

Q: What is Southlake Tricity Rba's specialty?

The primary specialty registered for this NPI is Custodial Care Facility with taxonomy code 311Z00000X.

Active since March 16, 2007CLIA 15D1013594 · Waiver

2075 RIPLEY ST, LAKE STATION, IN 46405(219) 962-9437 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Lake Park Residential Care NPPES

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

LAKE PARK RESIDENTIAL CARE (NPI 1972637171) is a healthcare organization registered as a custodial care facility in Lake Station, Indiana and active in the NPI registry since March 2007. The organization holds a CLIA Waiver certificate valid through June 11, 2027 and lists Robert D Krumwied, Ceo, as its authorized official.

NPPES Registry Identity

NPI1972637171

Entity TypeOrganization

Primary Taxonomy311Z00000X

Legal Business NameSOUTHLAKE TRICITY RBA

Location Address2075 RIPLEY STLake Station, IN 46405-1161

Mailing Address2075 Ripley StLake Station, IN 46405-1161

Phone(219) 962-9437

Organization SubpartNo

Authorized OfficialRobert D KrumwiedCeo · (219) 392-6010

Enumeration DateMarch 16, 2007

Last NPPES UpdateAugust 22, 2020

✔ NPI 1972637171 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCustodial Care FacilityNursing & Custodial Care Facilities

Taxonomy Code311Z00000X

Definition

A facility providing care that serves to assist an individual in the activities of daily living, such as assistance in walking, getting in and out of bed, bathing, dressing, feeding, and using the toilet, preparation of special diets, and supervision of medication that usually can be self-administered. Custodial care essentially is personal care that does not require the continuing attention of trained medical or paramedical personnel.

2075 RIPLEY ST, Lake Station, IN 46405

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Other Names 1

Doing Business AsLake Park Residential Care

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D1013594

Lake Park Residential Care · Lake Station, IN

Active · expires Jun 11, 2027

CLIA Number15D1013594

Laboratory TypeOther

Certificate Effective DateJune 12, 2025

Certificate Expiration DateJune 11, 2027

Laboratory DirectorDonna S. Waymire

Laboratory Phone(219) 962-9437

Laboratory LocationLake Park Residential Care2075 Ripley St, Lake Station, IN 46405

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

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

CHARLENE JACKSON

Licensed Practical Nurse

2075 RIPLEY ST
LAKE STATION, IN 46405

Lake County (219) 962-9437

JENNIFER MARIE LEGG LPN

Licensed Practical Nurse

2075 RIPLEY ST
LAKE STATION, IN 46405

Lake County (219) 962-5311

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 Southlake Tricity Rba's NPI number?

The NPI number for Southlake Tricity Rba is 1972637171. It was assigned to this organization in the NPPES registry on March 16, 2007. The provider is doing business as Lake Park Residential Care.

Where is Southlake Tricity Rba located?

Southlake Tricity Rba is located at 2075 Ripley St, Lake Station, IN 46405. The listed phone number is (219) 962-9437.

What is Southlake Tricity Rba's specialty?

The primary specialty registered for this NPI is Custodial Care Facility with taxonomy code 311Z00000X.

Does Southlake Tricity Rba hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D1013594) is associated with this NPI, valid through June 11, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Southlake Tricity Rba was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.