Provider Demographics
NPI:1972895720
Name:LAKE OKEECHOBEE ALF, LLC
Entity Type:Organization
Organization Name:LAKE OKEECHOBEE ALF, LLC
Other - Org Name:BELLE MEAD PALM BEACH COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:C
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-845-7767
Mailing Address - Street 1:631 US HIGHWAY 1
Mailing Address - Street 2:SUITE #303
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4617
Mailing Address - Country:US
Mailing Address - Phone:561-845-7767
Mailing Address - Fax:561-828-7641
Practice Address - Street 1:120 STATE MARKET RD
Practice Address - Street 2:
Practice Address - City:PAHOKEE
Practice Address - State:FL
Practice Address - Zip Code:33476-1542
Practice Address - Country:US
Practice Address - Phone:561-924-0010
Practice Address - Fax:561-924-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL119523104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL11952OtherACHA LICENSE