Lake Park SNF Operator LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LAKE PARK SNF OPERATOR LLC

Practice address

1304 S Market St
Lake Park, IA 51347-1060

Phone

(712) 832-3691

NPI assigned

Feb 19, 2021

Last updated

Feb 19, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Bruce Wertheim

Title

Sole Member

Phone

(813) 347-9453

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613692800000",
    "number": "1073106118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15310 AMBERLY DR STE 102",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336472145",
            "telephone_number": "813-347-9453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 S MARKET ST",
            "city": "LAKE PARK",
            "state": "IA",
            "postal_code": "513471060",
            "telephone_number": "712-832-3691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE PARK SNF OPERATOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-19",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A",
        "authorized_official_last_name": "WERTHEIM",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "813-347-9453",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Lake Park, IA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.