Provider Demographics
NPI:1215043427
Name:LAKE BALATON, INC.
Entity Type:Organization
Organization Name:LAKE BALATON, INC.
Other - Org Name:THE VILLAS OF CASA CELESTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-397-7272
Mailing Address - Street 1:9225 82ND AVENUE N.
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-2821
Mailing Address - Country:US
Mailing Address - Phone:727-397-7272
Mailing Address - Fax:727-319-3903
Practice Address - Street 1:9225 82ND AVENUE N.
Practice Address - Street 2:SUITE 312
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-2821
Practice Address - Country:US
Practice Address - Phone:727-397-7272
Practice Address - Fax:727-319-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL6681310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility