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NPI Code Detail

MEDICARE: LP LAKE WORTH LLC

MEDICARE: LP LAKE WORTH 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
1314000000XSkilled Nursing FacilitySNF1544096FL

General Provider Information

NPI Number : 1477744746
Entity Type Code : Organization
Provider Name (Legal Business Name) : LP LAKE WORTH LLC
Provider Business Mailing Address
First Line : 12201 BLUEGRASS PARKWAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2361
Country : US
Telephone Number : 502-568-7800
Fax Number : 502-568-7150
Provider Business Practice Location Address
First Line : 4405 LAKEWOOD RD
Second Line :
City : LAKE WORTH
State : FL
Zip : 33461-3414
Country : US
Telephone Number : 561-969-1400
Fax Number : 561-969-0121
Authorized Official
Title or Position : CFO
Name : MR. JOHN HARRISON
Credential :
Telephone Number : 502-568-7800
Provider Enumeration Date : 08/05/2007
Last Update Date : 10/19/2010

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