MEDICARE: LCS SANDHILL COVE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104302405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LCS SANDHILL COVE LLC

Provider Business Mailing Address
First Line	:	1500 SW CAPRI ST
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-4518
Country	:	US
Telephone Number	:	772-223-5863
Fax Number	:	772-283-7092

Provider Business Practice Location Address
First Line	:	1500 SW CAPRI ST
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-4518
Country	:	US
Telephone Number	:	772-223-5863
Fax Number	:	772-283-7092

Authorized Official
Title or Position	:	MANAGER OF MANAGING MEMBER
Name	:	DIANE C BRIDGEWATER
Credential	:
Telephone Number	:	515-875-4500

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	06/19/2019

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Directions to “LCS SANDHILL COVE LLC ” Practice Location

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