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NPI Code Detail

MEDICARE: SA-LAKELAND, LLC

MEDICARE: SA-LAKELAND, 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
1314000000XSkilled Nursing FacilitySNF14530961FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477559672
Entity Type Code : Organization
Provider Name (Legal Business Name) : SA-LAKELAND, LLC
Provider Business Mailing Address
First Line : 1919 LAKELAND HILLS BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33805-2901
Country : US
Telephone Number : 863-688-5612
Fax Number : 863-688-1398
Provider Business Practice Location Address
First Line : 1919 LAKELAND HILLS BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33805-2901
Country : US
Telephone Number : 863-688-5612
Fax Number : 863-687-8870
Authorized Official
Title or Position : COO
Name : MR. ALEX PALEY
Credential :
Telephone Number : 914-390-4363
Provider Enumeration Date : 06/22/2005
Last Update Date : 05/02/2014

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Directions to “SA-LAKELAND, LLC ” Practice Location

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