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General NPI Number Information
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NPI Number | 1508863911
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Entity Type | Organization
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Legal Business Name | ORLANDO LUTHERAN TOWERS INC
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 210 LAKE AVE
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City | ORLANDO
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State | FL
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Zip | 32801-3560
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Country | US
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Telephone | 407-872-7088
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Fax | 407-206-2388
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Provider Business Mailing Address
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Address Line | 300 E CHURCH ST
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City | ORLANDO
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State | FL
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Zip | 32801-3544
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Country | US
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Telephone | 407-872-7088
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Fax | 407-206-2388
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Authorized Official
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Title or Position | CEO
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Name | MRS. ALICIA MARIE LABRECQUE
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Credential | RPT, NHA
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Telephone | 407-466-4383
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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 | AL5267
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL11438
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | SNF1394096
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License Number State | FL
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