MEDICARE: LAKEVIEW MANOR ASSISTED LIVING FACILITY, INC.

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1801447503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEVIEW MANOR ASSISTED LIVING FACILITY, INC.

Provider Business Mailing Address
First Line	:	1320 CRANE CREST WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-4420
Country	:	US
Telephone Number	:	407-756-0237
Fax Number	:	407-412-5331

Provider Business Practice Location Address
First Line	:	5357 BROSCHE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-1709
Country	:	US
Telephone Number	:	407-756-0237
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/ OWNER
Name	:	ANALISA CORTEZ
Credential	:
Telephone Number	:	407-756-0237

Provider Enumeration Date	:	09/24/2019
Last Update Date	:	09/24/2019

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