Provider Demographics
NPI:1871670067
Name:AVANTE AT LAKE WORTH, INC.
Entity Type:Organization
Organization Name:AVANTE AT LAKE WORTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIEGASIWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-216-0101
Mailing Address - Street 1:5900 LAKE ELLENOR DR STE 700
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4643
Mailing Address - Country:US
Mailing Address - Phone:407-216-0101
Mailing Address - Fax:407-318-2477
Practice Address - Street 1:2501 N A ST
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-6013
Practice Address - Country:US
Practice Address - Phone:561-585-9301
Practice Address - Fax:561-533-5857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF10250961314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020323800Medicaid
FL105372Medicare Oscar/Certification