Provider Demographics
NPI:1629065933
Name:DELRAY GROUP, LLC
Entity Type:Organization
Organization Name:DELRAY GROUP, LLC
Other - Org Name:LAKE VIEW CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REINBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBAINA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:605-864-9191
Mailing Address - Street 1:5430 LINTON BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6512
Mailing Address - Country:US
Mailing Address - Phone:561-495-3188
Mailing Address - Fax:561-495-3190
Practice Address - Street 1:5430 LINTON BLVD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6512
Practice Address - Country:US
Practice Address - Phone:561-495-3188
Practice Address - Fax:561-495-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF12300962314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0-229-610-00Medicaid
FL022961000Medicaid
FL105475Medicare Oscar/Certification