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General NPI Number Information
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NPI Number | 1164391082
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Entity Type | Organization
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Legal Business Name | PCP LADY LAKE OPCO LLC
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Dates
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Enumeration Date | 10/30/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 955 S US HIGHWAY 441
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City | LADY LAKE
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State | FL
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Zip | 32159
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Country | US
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Telephone | 352-268-3523
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Fax |
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Provider Business Mailing Address
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Address Line | 2573 BARRINGTON CIR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-6805
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Country | US
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Telephone | 850-583-7990
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | SETH WALKER
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Credential |
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Telephone | 850-583-7990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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