Healthcare Provider Details

I. General information

NPI: 1447496625
Provider Name (Legal Business Name): LAKEVIEW MANOR ASSISTED LIVING FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5357 BROSCHE RD
ORLANDO FL
32807-1709
US

IV. Provider business mailing address

5357 BROSCHE RD
ORLANDO FL
32807-1709
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-7103
  • Fax:
Mailing address:
  • Phone: 407-277-7103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL4274
License Number StateFL

VIII. Authorized Official

Name: MRS. ESTERLITA S APOSTOL
Title or Position: VICE PRESIDENT
Credential: MED TECHNOLOGIST
Phone: 352-589-5144