Healthcare Provider Details

I. General information

NPI: 1811463144
Provider Name (Legal Business Name): LINDMAR LEGACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2018
Last Update Date: 10/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 LITTLE RD
TRINITY FL
34655-4421
US

IV. Provider business mailing address

2051 LITTLE RD
TRINITY FL
34655-4421
US

V. Phone/Fax

Practice location:
  • Phone: 727-267-4051
  • Fax: 844-481-0837
Mailing address:
  • Phone: 727-267-4051
  • Fax: 844-481-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM LINDMAR
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 727-267-4051