Healthcare Provider Details

I. General information

NPI: 1245547868
Provider Name (Legal Business Name): LAKE WALES HEALTH CARE OPERATIONS COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OVERLOOK DR
WINTER HAVEN FL
33884-1671
US

IV. Provider business mailing address

701 OVERLOOK DR
WINTER HAVEN FL
33884-1671
US

V. Phone/Fax

Practice location:
  • Phone: 863-318-5000
  • Fax:
Mailing address:
  • Phone: 863-318-5000
  • Fax:

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: MR. DWIGHT A OTT
Title or Position: SECRETARY/TREASURER
Credential: HFA
Phone: 765-664-5400