Healthcare Provider Details

I. General information

NPI: 1639889710
Provider Name (Legal Business Name): LAKE CROSSING HEALTH CENTER PAC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6698 WASHINGTON RD
APPLING GA
30802-4120
US

IV. Provider business mailing address

6698 WASHINGTON RD
APPLING GA
30802-4120
US

V. Phone/Fax

Practice location:
  • Phone: 706-541-0462
  • Fax: 706-541-0310
Mailing address:
  • Phone: 706-541-0462
  • Fax: 706-541-0310

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: ARI SILBERSTEIN
Title or Position: MEMBER OF LLC
Credential:
Phone: 631-292-1250