Provider Demographics
NPI:1508863911
Name:ORLANDO LUTHERAN TOWERS INC
Entity Type:Organization
Organization Name:ORLANDO LUTHERAN TOWERS INC
Other - Org Name:COMMONS AT ORLANDO LUTHERAN TOWERS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LABRECQUE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT, NHA
Authorized Official - Phone:407-466-4383
Mailing Address - Street 1:300 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3544
Mailing Address - Country:US
Mailing Address - Phone:407-872-7088
Mailing Address - Fax:407-206-2388
Practice Address - Street 1:210 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3560
Practice Address - Country:US
Practice Address - Phone:407-872-7088
Practice Address - Fax:407-206-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5267310400000X
FLAL11438310400000X
FLSNF1394096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020579600Medicaid
FLL6XOtherBLUE CROSS/SHIELD
FL05099Medicaid
FLL6XOtherBLUE CROSS BLUE SHIELD
FL020579600Medicaid