1770584211 NPI number — LAKE POINTE INVESTORS LLC

Table of content: (NPI 1770584211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770584211 NPI number — LAKE POINTE INVESTORS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKE POINTE INVESTORS LLC
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:
THE SPRINGS AT LAKE POINTE WOODS
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:
1770584211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2123 CENTRE POINTE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLAHASSEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32308-4930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-386-2831
Provider Business Mailing Address Fax Number:
850-386-2016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3280 LAKE POINTE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34231-6896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-929-2700
Provider Business Practice Location Address Fax Number:
941-929-2593
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
850-386-2831

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , 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: 026878000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com