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NPI Code Detail

MEDICARE: SH BECKETT LAKE, LLC.

MEDICARE: SH BECKETT LAKE, 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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110143OTHERFLALF LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841837143
Entity Type Code : Organization
Provider Name (Legal Business Name) : SH BECKETT LAKE, LLC.
Provider Business Mailing Address
First Line : 2573 BARRINGTON CIR
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-6805
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2155 MONTCLAIR RD
Second Line :
City : CLEARWATER
State : FL
Zip : 33763-4287
Country : US
Telephone Number : 727-797-7257
Fax Number :
Authorized Official
Title or Position : CFO
Name : SETH WALKER
Credential :
Telephone Number : 850-583-7990
Provider Enumeration Date : 12/05/2019
Last Update Date : 02/26/2020

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Directions to “SH BECKETT LAKE, LLC. ” Practice Location

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