MEDICARE: BEAR LAKE RETIREMENT HOME

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	AL8413	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962849778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAR LAKE RETIREMENT HOME

Provider Business Mailing Address
First Line	:	1525 BEAR LAKE RD
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-6736
Country	:	US
Telephone Number	:	407-296-7075
Fax Number	:	321-445-4740

Provider Business Practice Location Address
First Line	:	1525 BEAR LAKE RD
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-6736
Country	:	US
Telephone Number	:	407-296-7075
Fax Number	:	321-445-4740

Authorized Official
Title or Position	:	OWNER
Name	:	MARINA NIEVES
Credential	:
Telephone Number	:	407-296-7075

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	06/03/2013

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Directions to “BEAR LAKE RETIREMENT HOME ” Practice Location

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