Provider Demographics
NPI:1467026153
Name:LAKE HOWARD 1818 OPCO, LLC
Entity Type:Organization
Organization Name:LAKE HOWARD 1818 OPCO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-490-7920
Mailing Address - Street 1:2700 HIGHWAY 280 S STE 460
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-5407
Mailing Address - Country:US
Mailing Address - Phone:877-402-8527
Mailing Address - Fax:
Practice Address - Street 1:650 N LAKE HOWARD DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-3162
Practice Address - Country:US
Practice Address - Phone:863-293-3171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility