Organization · NPI-2

Club At Lake Gibson LLC

Skilled Nursing Facility · Lakeland, FL

NPI number1407684582
StatusActive
Last updated in NPPESJul 22, 2024

Details

NPI
1407684582
Entity type
Organization (NPI-2)
Legal business name
Club At Lake Gibson LLC
Organization subpart
No
Enumeration date
Jul 22, 2024
Certification date
Jul 22, 2024
Last updated
Jul 22, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
314000000X Skilled Nursing Facility––Yes

Practice location

855 Carpenters Way
Lakeland, FL 33809-4157

Phone 863-213-3335

Mailing address

855 Carpenters Way
Lakeland, FL 33809-4157

Authorized official

Aharon Katz
Authorized Member
9177572121

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