Healthcare Provider Details

I. General information

NPI: 1174999726
Provider Name (Legal Business Name): LAKELAND NURSING AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 LAKELAND HILLS BLVD
LAKELAND FL
33805-2901
US

IV. Provider business mailing address

7383 N LINCOLN AVE SUITE 100
LINCOLNWOOD IL
60712-1734
US

V. Phone/Fax

Practice location:
  • Phone: 863-688-5612
  • Fax:
Mailing address:
  • Phone: 847-440-2233
  • Fax:

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: MOSHE DAVID ARYEH
Title or Position: MEMBER
Credential:
Phone: 847-440-2233