MEDICARE: BENEVA LAKES HEALTH CARE ASSOCIATES 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	SNF1049096	FL

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	:	1306891098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENEVA LAKES HEALTH CARE ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	741 S BENEVA RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232-2411
Country	:	US
Telephone Number	:	941-957-0310
Fax Number	:	941-365-7324

Provider Business Practice Location Address
First Line	:	741 S BENEVA RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232-2411
Country	:	US
Telephone Number	:	941-957-0310
Fax Number	:	941-365-7324

Authorized Official
Title or Position	:	MANAGER
Name	:	BRAD J. LEE
Credential	:
Telephone Number	:	941-957-0310

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	08/02/2012

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