Provider Demographics
NPI:1891991311
Name:LEXINGTON TERRACE ALF, LLC
Entity Type:Organization
Organization Name:LEXINGTON TERRACE ALF, LLC
Other - Org Name:LEXINGTON TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-635-9500
Mailing Address - Street 1:6340 46TH AVE N
Mailing Address - Street 2:
Mailing Address - City:KENNETH CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33709-3104
Mailing Address - Country:US
Mailing Address - Phone:727-547-9566
Mailing Address - Fax:727-547-2601
Practice Address - Street 1:6340 46TH AVE N
Practice Address - Street 2:
Practice Address - City:KENNETH CITY
Practice Address - State:FL
Practice Address - Zip Code:33709-3104
Practice Address - Country:US
Practice Address - Phone:727-547-9566
Practice Address - Fax:727-547-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8418310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility