Healthcare Provider Details

I. General information

NPI: 1588665251
Provider Name (Legal Business Name): SURREY PLACE OF LACANTO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 W MARC KNIGHTON CT
LECANTO FL
34461-8334
US

IV. Provider business mailing address

2123 CENTRE POINTE BLVD
TALLAHASSEE FL
32308-4930
US

V. Phone/Fax

Practice location:
  • Phone: 352-746-9500
  • Fax: 352-746-9666
Mailing address:
  • Phone: 850-386-2831
  • Fax: 850-386-2016

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: MR. JOSEPH D. MITCHELL
Title or Position: PRESIDENT
Credential:
Phone: 850-386-2831