MEDICARE: AVANTE AT LAKE WORTH, 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	314000000X	Skilled Nursing Facility	SNF10250961	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	:	1871670067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVANTE AT LAKE WORTH, INC.

Provider Business Mailing Address
First Line	:	5900 LAKE ELLENOR DR STE 700
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-4643
Country	:	US
Telephone Number	:	407-216-0101
Fax Number	:	407-318-2477

Provider Business Practice Location Address
First Line	:	2501 N A ST
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33460-6013
Country	:	US
Telephone Number	:	561-585-9301
Fax Number	:	561-533-5857

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIMBERLY L. BIEGASIWICZ
Credential	:
Telephone Number	:	407-216-0101

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	03/17/2022

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