Provider Demographics
NPI:1932685880
Name:LANIER REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:LANIER REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-830-5309
Mailing Address - Street 1:101 SUNNYTOWN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3862
Mailing Address - Country:US
Mailing Address - Phone:470-830-5309
Mailing Address - Fax:470-830-7775
Practice Address - Street 1:12740 LANIER RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-1704
Practice Address - Country:US
Practice Address - Phone:904-757-2548
Practice Address - Fax:904-475-7047
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOVEREIGN HEALTHCARE HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility