Provider Demographics
NPI:1528369139
Name:A DREAM LAKE MANOR INC
Entity Type:Organization
Organization Name:A DREAM LAKE MANOR INC
Other - Org Name:APOPKA RETIREMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:YAP
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-292-6241
Mailing Address - Street 1:750 ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5424
Mailing Address - Country:US
Mailing Address - Phone:407-886-4353
Mailing Address - Fax:
Practice Address - Street 1:750 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5424
Practice Address - Country:US
Practice Address - Phone:407-886-4353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5921310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140953100Medicaid