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NPI Code Detail

MEDICARE: VTR ANTHEM LAKES, LLC

MEDICARE: VTR ANTHEM LAKES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1053206615
Entity Type Code : Organization
Provider Name (Legal Business Name) : VTR ANTHEM LAKES, LLC
Provider Business Mailing Address
First Line : 2573 BARRINGTON CIR
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-6805
Country : US
Telephone Number : 850-583-7990
Fax Number :
Provider Business Practice Location Address
First Line : 905 ASSISI LN
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32233-2972
Country : US
Telephone Number : 904-583-5399
Fax Number :
Authorized Official
Title or Position : CFO
Name : SETH WALKER
Credential :
Telephone Number : 850-583-7990
Provider Enumeration Date : 06/12/2025
Last Update Date : 06/12/2025

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