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NPI Code Detail

MEDICARE: LAKE CITY CENTER FOR NURSING AND HEALING LLC

MEDICARE: LAKE CITY CENTER FOR NURSING AND HEALING 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 Facility

General Provider Information

NPI Number : 1730053745
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKE CITY CENTER FOR NURSING AND HEALING LLC
Provider Business Mailing Address
First Line : 2055 REX RD
Second Line :
City : LAKE CITY
State : GA
Zip : 30260-3944
Country : US
Telephone Number : 404-361-1028
Fax Number :
Provider Business Practice Location Address
First Line : 2055 REX RD
Second Line :
City : LAKE CITY
State : GA
Zip : 30260-3944
Country : US
Telephone Number : 404-361-1028
Fax Number :
Authorized Official
Title or Position : MEMBER OF LLC
Name : SHLOMO E HELLER
Credential :
Telephone Number : 470-737-0111
Provider Enumeration Date : 10/02/2025
Last Update Date : 10/02/2025

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Directions to “LAKE CITY CENTER FOR NURSING AND HEALING LLC ” Practice Location

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