Shady Lane Retirement Home

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL6001 Issued in FL

Legal business name

SHADY LANE RETIREMENT HOME

Practice address

201 Rosefield Ave
Leesburg, FL 34748-5014

Phone

(352) 728-1559

Fax

(352) 728-1703

NPI assigned

Nov 1, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Segundo Lizardo

Title

Owner/Administrator

Phone

(352) 728-1559

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1257033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257033600000",
    "number": "1114253754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 ROSEFIELD AVE",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485014",
            "telephone_number": "352-728-1559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 ROSEFIELD AVE",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485014",
            "telephone_number": "352-728-1559",
            "fax_number": "352-728-1703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY LANE RETIREMENT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-01",
        "last_updated": "2009-11-01",
        "status": "A",
        "authorized_official_last_name": "LIZARDO",
        "authorized_official_first_name": "SEGUNDO",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "352-728-1559",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL6001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2209282005070",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ronald James Seymour, PT
• Kinnar Rameshchandra Shah, DMD
• Shakti Narain MD PA
• Fouad M Shami, MD
• Scott Shapiro, MD
• Ashok K Sharma, M.D.

• Assisted Living Facility in Leesburg, FL
• Providers in Leesburg, 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 1, 2009; 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.