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General NPI Number Information
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NPI Number | 1447872601
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Entity Type | Organization
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Legal Business Name | LUBIS ENTERPRISE LLC
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 39106 GRAYS AIRPORT RD
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City | LADY LAKE
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State | FL
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Zip | 32159-4004
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Country | US
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Telephone | 352-750-9150
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Fax |
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Provider Business Mailing Address
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Address Line | 39106 GRAYS AIRPORT RD
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City | LADY LAKE
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State | FL
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Zip | 32159-4004
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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 | OWNER
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Name | DEVIANO LUBIS
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Credential |
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Telephone | 352-787-3034
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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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