Provider Demographics
NPI:1811463144
Name:LINDMAR LEGACY, LLC
Entity type:Organization
Organization Name:LINDMAR LEGACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-267-4051
Mailing Address - Street 1:2051 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4421
Mailing Address - Country:US
Mailing Address - Phone:727-267-4051
Mailing Address - Fax:844-481-0837
Practice Address - Street 1:2051 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4421
Practice Address - Country:US
Practice Address - Phone:727-267-4051
Practice Address - Fax:844-481-0837
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINDMAR LEGACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-14
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9424OtherAHCA