Provider Demographics
NPI:1093705394
Name:LEESBURG REGIONAL MEDICAL CENTER D/B/A LRMC NURSING CENTER
Entity Type:Organization
Organization Name:LEESBURG REGIONAL MEDICAL CENTER D/B/A LRMC NURSING CENTER
Other - Org Name:LRMC NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-323-5500
Mailing Address - Street 1:700 N PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4419
Mailing Address - Country:US
Mailing Address - Phone:352-323-5500
Mailing Address - Fax:352-323-5509
Practice Address - Street 1:700 N PALMETTO ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4419
Practice Address - Country:US
Practice Address - Phone:352-323-5500
Practice Address - Fax:352-323-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF12990961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105621Medicare ID - Type Unspecified