Healthcare Provider Details

I. General information

NPI: 1023972932
Provider Name (Legal Business Name): LAKE WALES SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N SCENIC HWY
LAKE WALES FL
33853-3208
US

IV. Provider business mailing address

730 N SCENIC HWY
LAKE WALES FL
33853-3208
US

V. Phone/Fax

Practice location:
  • Phone: 863-676-1512
  • Fax:
Mailing address:
  • Phone: 863-676-1512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AHARON KATZ
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 917-757-2121