Provider Demographics
NPI:1568409746
Name:SENIOR CARE GROUP, INC
Entity Type:Organization
Organization Name:SENIOR CARE GROUP, INC
Other - Org Name:LAKESHORE VILLAS HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUDOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-341-2735
Mailing Address - Street 1:16002 LAKESHORE VILLA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1367
Mailing Address - Country:US
Mailing Address - Phone:813-968-5093
Mailing Address - Fax:813-264-0476
Practice Address - Street 1:16002 LAKESHORE VILLA DRIVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1367
Practice Address - Country:US
Practice Address - Phone:813-968-5093
Practice Address - Fax:813-264-0476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF12820963140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021805700Medicaid
FL105542Medicare Oscar/Certification