Provider Demographics
NPI:1275006504
Name:INNOVATIVE MEDICAL MANAGEMENT SOLUTIONS LLC
Entity Type:Organization
Organization Name:INNOVATIVE MEDICAL MANAGEMENT SOLUTIONS LLC
Other - Org Name:THE LAKES OF CLERMONT HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-415-7589
Mailing Address - Street 1:4042 PARK OAKS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-9539
Mailing Address - Country:US
Mailing Address - Phone:813-675-2289
Mailing Address - Fax:
Practice Address - Street 1:1775 HOOKS STREET
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:813-635-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-09
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility