Seminole Acres/Kanlake II, Inc.

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

AL9025 Issued in FL

Legal business name

SEMINOLE ACRES/KANLAKE II, INC.

Practice address

3562 Seminole Rd
Fort Pierce, FL 34951-4041

Phone

(772) 595-5565

Fax

(772) 595-6505

NPI assigned

Oct 4, 2011

Organization subpart

No

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

Authorized official

Name

Kamlawaty Lakram, CORE TRAINING

Title

Administrator

Phone

(772) 595-5565

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1317686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317686400000",
    "number": "1124302617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3562 SEMINOLE RD",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349514041",
            "telephone_number": "772-595-5565",
            "fax_number": "772-595-6505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3562 SEMINOLE RD",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349514041",
            "telephone_number": "772-595-5565",
            "fax_number": "772-595-6505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEMINOLE ACRES/KANLAKE II, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-04",
        "last_updated": "2011-10-04",
        "status": "A",
        "authorized_official_last_name": "LAKRAM",
        "authorized_official_first_name": "KAMLAWATY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "772-595-5565",
        "authorized_official_credential": "CORE TRAINING"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "FL",
            "license": "AL9025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003720100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in Fort Pierce, FL
• Providers in Fort Pierce, FL by specialty
• Assisted Living Facility (Mental Illness) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; 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.