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General NPI Number Information
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NPI Number | 1578413134
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Entity Type | Organization
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Legal Business Name | GREAT EXPECTATIONS OF LAKE COUNTY CORPORATION
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 5345 TWIN PALMS RD
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City | FRUITLAND PARK
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State | FL
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Zip | 34731-6050
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Country | US
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Telephone | 352-314-0202
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Fax | 352-504-0233
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Provider Business Mailing Address
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Address Line | 1310 W NORTH BLVD STE 2
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City | LEESBURG
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State | FL
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Zip | 34748-3922
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Country | US
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Telephone | 352-314-0202
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Fax | 352-504-0233
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | TINA MARIE FLANNERY
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Credential |
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Telephone | 352-460-7009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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