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General NPI Number Information
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NPI Number | 1457306797
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Entity Type | Organization
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Legal Business Name | SANDLAKE LIVING ASSISTING HOME
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7798 ORTEGA BLUFF PKWY
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City | JACKSONVILLE
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State | FL
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Zip | 32244-8209
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Country | US
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Telephone | 904-779-6878
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Fax | 904-772-7733
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Provider Business Mailing Address
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Address Line | 7798 ORTEGA BLUFF PKWY
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City | JACKSONVILLE
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State | FL
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Zip | 32244-8209
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Country | US
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Telephone | 904-779-6878
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Fax | 904-772-7733
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Authorized Official
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Title or Position | CEO
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Name | MS. LASHAWNDA KIM LEWIS
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Credential |
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Telephone | 904-779-6878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State | FL
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