Provider Demographics
NPI:1477858520
Name:LWRC INC
Entity Type:Organization
Organization Name:LWRC INC
Other - Org Name:LAKE WIRE RETIREMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-686-7306
Mailing Address - Street 1:315 W PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-1531
Mailing Address - Country:US
Mailing Address - Phone:863-686-7306
Mailing Address - Fax:863-680-3375
Practice Address - Street 1:315 W PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-1531
Practice Address - Country:US
Practice Address - Phone:863-686-7306
Practice Address - Fax:863-680-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5874310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140465200Medicaid