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General NPI Number Information
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NPI Number | 1306709233
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Entity Type | Organization
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Legal Business Name | LAKE PARK NURSING & REHAB CENTER LLC
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 259 SW CAPTAIN BROWN RD
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City | MADISON
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State | FL
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Zip | 32340-4316
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Country | US
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Telephone | 270-594-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 259 SW CAPTAIN BROWN RD
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City | MADISON
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State | FL
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Zip | 32340-4316
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MOSHE KELMAN
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Credential |
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Telephone | 917-613-1662
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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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