Still Waters of Lake City, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL9472 Issued in FL

Legal business name

STILL WATERS OF LAKE CITY, INC.

Practice address

507 NW Hall of Fame Dr
Lake City, FL 32055-4835

Phone

(386) 755-6560

Fax

(386) 628-5018

NPI assigned

Nov 15, 2012

Organization subpart

No

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

Authorized official

Name

Threasa Hysell, R.N.

Title

Executive Director

Phone

(386) 755-6560

Specialties & licenses 4

Addresses

Other identifiers 1

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352937600000",
    "number": "1104160027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 NW HALL OF FAME DR",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320554835",
            "telephone_number": "386-755-6560",
            "fax_number": "386-628-5018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 NW HALL OF FAME DR",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320554835",
            "telephone_number": "386-755-6560",
            "fax_number": "386-628-5018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILL WATERS OF LAKE CITY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-15",
        "last_updated": "2012-11-15",
        "status": "A",
        "authorized_official_last_name": "HYSELL",
        "authorized_official_first_name": "THREASA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "386-755-6560",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL9472",
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "FL",
            "license": "AL9472",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "FL",
            "license": "AL9472",
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "FL",
            "license": "AL9472",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID WAIVER",
            "identifier": "682130800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sophia Lauada Sterling
• Maddison Marcia Stetson, LMT
• Lyn M Stevens
• Corniqueca Stewart-Simmons, ARNP
• Rosa Stewart
• Johanna Lynn Stith, APRN
• Madden Elizabeth Stockstill, PHARMD
• Ezra L Stone, LCSW
• Jenifer B. Stover, PA-C
• Kimberly Stratton, LMHC

• Assisted Living Facility in Lake City, FL
• Providers in Lake City, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; 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.