Healthcare Provider Details

I. General information

NPI: 1689616096
Provider Name (Legal Business Name): SP LAFAYETTE VILLA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 LLEWELLYN AVE
NORFOLK VA
23504-1203
US

IV. Provider business mailing address

800 CONCOURSE PKWY S SUITE 200
MAITLAND FL
32751-6148
US

V. Phone/Fax

Practice location:
  • Phone: 757-625-5363
  • Fax: 757-627-3161
Mailing address:
  • Phone: 407-571-1550
  • Fax: 407-571-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2603
License Number StateVA

VIII. Authorized Official

Name: JOSEPH CONTE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 407-571-1550