Provider Demographics
NPI:1013070002
Name:LAKE WORTH ENTERPRISE LLC
Entity Type:Organization
Organization Name:LAKE WORTH ENTERPRISE LLC
Other - Org Name:OASIS HEALTH AND REHABILITATION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBAINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-864-9191
Mailing Address - Street 1:1201 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-5409
Mailing Address - Country:US
Mailing Address - Phone:561-586-7404
Mailing Address - Fax:561-586-7404
Practice Address - Street 1:1201 12TH AVE S
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-5409
Practice Address - Country:US
Practice Address - Phone:561-586-7404
Practice Address - Fax:561-586-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0-266-124-00Medicaid
FL105659Medicare Oscar/Certification