MEDICARE: SWAN AT LAKE CONWAY

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	251J00000X	Nursing Care Agency	11542	FL

General Provider Information

NPI Number	:	1982045753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWAN AT LAKE CONWAY

Provider Business Mailing Address
First Line	:	3714 SAINT MORITZ ST
Second Line	:
City	:	BELLE ISLE
State	:	FL
Zip	:	32812-1135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3714 SAINT MORITZ ST
Second Line	:
City	:	BELLE ISLE
State	:	FL
Zip	:	32812-1135
Country	:	US
Telephone Number	:	407-860-0266
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASTER WORKU BATI
Credential	:
Telephone Number	:	407-860-0266

Provider Enumeration Date	:	07/09/2013
Last Update Date	:	07/09/2013

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Directions to “SWAN AT LAKE CONWAY ” Practice Location

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