Healthcare Provider Details

I. General information

NPI: 1376452763
Provider Name (Legal Business Name): SS POLK II COMMUNITY HC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 S 11TH ST
LAKE WALES FL
33853-4901
US

IV. Provider business mailing address

512 S 11TH ST
LAKE WALES FL
33853-4901
US

V. Phone/Fax

Practice location:
  • Phone: 863-676-8502
  • Fax:
Mailing address:
  • Phone:
  • 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: ALICIA CEPEDA
Title or Position: SENIOR LEGAL/RISK MANAGER
Credential:
Phone: 385-342-5175