Provider Demographics
NPI:1154674166
Name:LAKE KARL PROPERTIES, INC.
Entity Type:Organization
Organization Name:LAKE KARL PROPERTIES, INC.
Other - Org Name:HUDSON MANOR ALF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DAMIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-856-5282
Mailing Address - Street 1:13009 LAKE KARL DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34669-2374
Mailing Address - Country:US
Mailing Address - Phone:727-856-5282
Mailing Address - Fax:727-856-7163
Practice Address - Street 1:13009 LAKE KARL DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34669-2374
Practice Address - Country:US
Practice Address - Phone:727-856-5282
Practice Address - Fax:727-856-7163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL38310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689665100Medicaid