Provider Demographics
NPI:1336104975
Name:FIVE POINTS HEALTHCARE LTD.
Entity Type:Organization
Organization Name:FIVE POINTS HEALTHCARE LTD.
Other - Org Name:LAKESIDE NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LANELLE
Authorized Official - Middle Name:NATHEY
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-714-3793
Mailing Address - Street 1:11411 ARMSDALE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-3311
Mailing Address - Country:US
Mailing Address - Phone:904-714-3793
Mailing Address - Fax:904-714-3799
Practice Address - Street 1:11411 ARMSDALE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-3311
Practice Address - Country:US
Practice Address - Phone:904-714-3793
Practice Address - Fax:904-714-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105980Medicare ID - Type Unspecified