Provider Demographics
NPI:1972945087
Name:LIFECARE OF LAKELAND, LLC
Entity Type:Organization
Organization Name:LIFECARE OF LAKELAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ST ROCK
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:863-937-9659
Mailing Address - Street 1:625 SCHOOLHOUSE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2615
Mailing Address - Country:US
Mailing Address - Phone:863-937-9659
Mailing Address - Fax:863-937-9662
Practice Address - Street 1:625 SCHOOLHOUSE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2615
Practice Address - Country:US
Practice Address - Phone:863-937-9659
Practice Address - Fax:863-937-9662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health