Provider Demographics
NPI:1922495530
Name:CRP LAKESHORE VILLAS, L.L.C.
Entity Type:Organization
Organization Name:CRP LAKESHORE VILLAS, L.L.C.
Other - Org Name:RENAISSANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL SUPERVISOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CATOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-512-8744
Mailing Address - Street 1:16001 LAKESHORE VILLA DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1336
Mailing Address - Country:US
Mailing Address - Phone:813-386-1145
Mailing Address - Fax:813-514-9103
Practice Address - Street 1:16001 LAKESHORE VILLA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1336
Practice Address - Country:US
Practice Address - Phone:813-386-1145
Practice Address - Fax:813-514-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7531310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility