Provider Demographics
NPI:1447603303
Name:LAKE COUNTY ADULT ACTIVITY CENTER INC
Entity Type:Organization
Organization Name:LAKE COUNTY ADULT ACTIVITY CENTER INC
Other - Org Name:LAKE COUNTY ADULT DAY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-404-6098
Mailing Address - Street 1:1934 N DONNELLY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757
Mailing Address - Country:US
Mailing Address - Phone:352-404-6098
Mailing Address - Fax:352-404-6475
Practice Address - Street 1:1934 N DONNELLY ST
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757
Practice Address - Country:US
Practice Address - Phone:352-404-6098
Practice Address - Fax:352-404-6475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9285385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care