Healthcare Provider Details

I. General information

NPI: 1902175656
Provider Name (Legal Business Name): 7950 LAKE UNDERHILL ROAD OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 11/27/2023
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 LAKE UNDERHILL RD
ORLANDO FL
32822-8229
US

IV. Provider business mailing address

7950 LAKE UNDERHILL RD
ORLANDO FL
32822-8229
US

V. Phone/Fax

Practice location:
  • Phone: 407-658-2046
  • Fax: 407-249-2226
Mailing address:
  • Phone: 407-658-2046
  • Fax: 407-249-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF14370961
License Number StateFL

VIII. Authorized Official

Name: KENNETH USSERY
Title or Position: VP
Credential:
Phone: 407-571-1550