Healthcare Provider Details

I. General information

NPI: 1093720757
Provider Name (Legal Business Name): LAKESHORE ESTATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 FERNBROOK LN
NASHVILLE TN
37214-1623
US

IV. Provider business mailing address

3025 FERNBROOK LN
NASHVILLE TN
37214-1623
US

V. Phone/Fax

Practice location:
  • Phone: 615-885-2320
  • Fax: 615-885-3439
Mailing address:
  • Phone: 615-885-2320
  • Fax: 615-885-3439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number396
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number56
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID A SCIORTINO SR.
Title or Position: PRESIDENT
Credential:
Phone: 615-646-4466