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General NPI Number Information
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NPI Number | 1245547868
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Entity Type | Organization
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Legal Business Name | LAKE WALES HEALTH CARE OPERATIONS COMPANY LLC
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 10/01/2010
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Provider Practice Location Address
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Address Line | 701 OVERLOOK DR
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City | WINTER HAVEN
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State | FL
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Zip | 33884-1671
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Country | US
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Telephone | 863-318-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 701 OVERLOOK DR
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City | WINTER HAVEN
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State | FL
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Zip | 33884-1671
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Country | US
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Telephone | 863-318-5000
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Fax |
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | MR. DWIGHT A OTT
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Credential | HFA
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Telephone | 765-664-5400
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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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