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General NPI Number Information
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NPI Number | 1063263861
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Entity Type | Organization
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Legal Business Name | LAKE WORTH REHABILITATION CENTER LLC
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Dates
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Enumeration Date | 03/29/2024
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 1201 12TH AVE S
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City | LAKE WORTH
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State | FL
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Zip | 33460-5409
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Country | US
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Telephone | 561-586-7404
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Fax |
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Provider Business Mailing Address
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Address Line | 101 SUNNYTOWN RD STE 201
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City | CASSELBERRY
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State | FL
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Zip | 32707-3862
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Country | US
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Telephone | 407-215-8610
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | DONALD MELTON
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Credential |
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Telephone | 407-215-8610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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