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General NPI Number Information
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NPI Number | 1083788053
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Entity Type | Organization
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Legal Business Name | LAKELAND NURSING AND REHABILITATION CENTER, LLC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 3680 LAKELAND LN
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City | JACKSON
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State | MS
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Zip | 39216-4707
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Country | US
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Telephone | 601-982-5505
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Fax | 601-362-1883
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Provider Business Mailing Address
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Address Line | PO BOX 428
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City | ORCHARD PARK
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State | NY
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Zip | 14127-0428
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Country | US
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Telephone | 716-662-4955
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Fax | 716-667-9230
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Authorized Official
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Title or Position | CO-CHIEF EXECUTIVE OFFICER
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Name | MR. NORBERT A BENNETT
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Credential |
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Telephone | 716-662-4955
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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 | 385
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License Number State | MS
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