Provider Demographics
NPI:1376023945
Name:LITHIA ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:LITHIA ASSISTED LIVING LLC
Other - Org Name:TWIN CREEKS ASSISTED LIVING & MEMORY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN KLEECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-278-5800
Mailing Address - Street 1:13470 BOYETTE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5706
Mailing Address - Country:US
Mailing Address - Phone:813-278-5800
Mailing Address - Fax:813-278-5906
Practice Address - Street 1:13470 BOYETTE RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569
Practice Address - Country:US
Practice Address - Phone:813-278-5800
Practice Address - Fax:813-278-5906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13122310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility