Provider Demographics
NPI:1245547868
Name:LAKE WALES HEALTH CARE OPERATIONS COMPANY LLC
Entity type:Organization
Organization Name:LAKE WALES HEALTH CARE OPERATIONS COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:A
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:HFA
Authorized Official - Phone:765-664-5400
Mailing Address - Street 1:701 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-1671
Mailing Address - Country:US
Mailing Address - Phone:863-318-5000
Mailing Address - Fax:
Practice Address - Street 1:701 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-1671
Practice Address - Country:US
Practice Address - Phone:863-318-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility