Healthcare Provider Details

I. General information

NPI: 1730053745
Provider Name (Legal Business Name): LAKE CITY CENTER FOR NURSING AND HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 REX RD
LAKE CITY GA
30260-3944
US

IV. Provider business mailing address

2055 REX RD
LAKE CITY GA
30260-3944
US

V. Phone/Fax

Practice location:
  • Phone: 404-361-1028
  • Fax:
Mailing address:
  • Phone: 404-361-1028
  • 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: SHLOMO E HELLER
Title or Position: MEMBER OF LLC
Credential:
Phone: 470-737-0111