Provider Demographics
NPI:1881640829
Name:SPANISH GARDENS HEALTH CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:SPANISH GARDENS HEALTH CARE ASSOCIATES LLC
Other - Org Name:LAKESIDE OAKS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GAITAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-733-4189
Mailing Address - Street 1:1061 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-7326
Mailing Address - Country:US
Mailing Address - Phone:727-733-4189
Mailing Address - Fax:727-734-7651
Practice Address - Street 1:1061 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-7326
Practice Address - Country:US
Practice Address - Phone:727-733-4189
Practice Address - Fax:727-734-7651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF15100962314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025248400Medicaid
FL025248400Medicaid