1154674166 NPI number — LAKE KARL PROPERTIES, INC.

Table of content: (NPI 1154674166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154674166 NPI number — LAKE KARL PROPERTIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKE KARL PROPERTIES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HUDSON MANOR ALF
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154674166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13009 LAKE KARL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34669-2374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-856-5282
Provider Business Mailing Address Fax Number:
727-856-7163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13009 LAKE KARL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34669-2374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-856-5282
Provider Business Practice Location Address Fax Number:
727-856-7163
Provider Enumeration Date:
10/16/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAMIANI
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
727-856-5282

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL38 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 689665100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 013663600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".