Healthcare Provider Details

I. General information

NPI: 1285943324
Provider Name (Legal Business Name): LAKE CITY REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 SW MCFARLANE AVE
LAKE CITY FL
32025-5614
US

IV. Provider business mailing address

560 SW MCFARLANE AVE
LAKE CITY FL
32025-5614
US

V. Phone/Fax

Practice location:
  • Phone: 386-758-4777
  • Fax: 386-961-9296
Mailing address:
  • Phone: 386-758-4777
  • Fax: 386-961-9296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: JOHN E WARREN
Title or Position: MGR
Credential:
Phone: 386-758-4777