Healthcare Provider Details

I. General information

NPI: 1104302405
Provider Name (Legal Business Name): LCS SANDHILL COVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SW CAPRI ST
PALM CITY FL
34990-4518
US

IV. Provider business mailing address

1500 SW CAPRI ST
PALM CITY FL
34990-4518
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-5863
  • Fax: 772-283-7092
Mailing address:
  • Phone: 772-223-5863
  • Fax: 772-283-7092

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: DIANE C BRIDGEWATER
Title or Position: MANAGER OF MANAGING MEMBER
Credential:
Phone: 515-875-4500