Provider Demographics
NPI:1508257023
Name:CRANE'S VIEW LODGE LLC
Entity Type:Organization
Organization Name:CRANE'S VIEW LODGE LLC
Other - Org Name:CRANE'S VIEW LODGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR - ASSET MANAGEMEN
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CARLTON
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-891-1258
Mailing Address - Street 1:1601 HOOK ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3510
Mailing Address - Country:US
Mailing Address - Phone:352-241-7960
Mailing Address - Fax:
Practice Address - Street 1:1601 HOOK ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3510
Practice Address - Country:US
Practice Address - Phone:352-241-7960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12546310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility