Healthcare Provider Details

I. General information

NPI: 1255851168
Provider Name (Legal Business Name): THE LEXINGTON MANOR ADULT FAMILY HOMECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 PINETTA CIR
WELLINGTON FL
33414
US

IV. Provider business mailing address

1337 PINETTA CIR
WELLINGTON FL
33414-6015
US

V. Phone/Fax

Practice location:
  • Phone: 561-422-7059
  • Fax: 561-508-4797
Mailing address:
  • Phone: 561-422-7059
  • Fax: 561-508-4797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL13025
License Number StateFL

VIII. Authorized Official

Name: MR. JONAS AUGUSTE
Title or Position: PRESIDENT
Credential:
Phone: 561-422-7059