Lakeside TLF, LLC

Primary specialty

Rehabilitation HospitalTaxonomy code 283X00000X

Legal business name

LAKESIDE TLF, LLC

Doing business as

Lakeside Neurologic

Practice address

1962 Vandolah Rd
Wauchula, FL 33873-8726

Phone

(800) 697-5390

NPI assigned

Nov 17, 2020

Last updated

Nov 17, 2020By 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

Dr. Maneesh Bansal, MD

Title

Coo

Phone

(800) 697-5390

Specialties & licenses 4

Addresses

Other names 1

• Lakeside Neurologic Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Terrence Delikat, DO

  • Family Medicine Physician
  • Bartow, FL
  • NPI 1154326775
  NPD (past)
• Waguih El Masry, M.D

  • Internal Medicine Physician
  • Bradenton, FL
  • NPI 1336103167
  NPD (past)

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605571200000",
    "number": "1134722820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10866 WASHINGTON BLVD STE 42",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902323610",
            "telephone_number": "213-986-8416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1962 VANDOLAH RD",
            "city": "WAUCHULA",
            "state": "FL",
            "postal_code": "338738726",
            "telephone_number": "800-697-5390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1044 S Florida Ave",
            "address_purpose": "LOCATION",
            "city": "Wauchula",
            "state": "FL",
            "postal_code": "338733412",
            "country_code": "US",
            "telephone_number": "863-773-2857",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKESIDE TLF, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-17",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A",
        "authorized_official_last_name": "BANSAL",
        "authorized_official_first_name": "MANEESH",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "800-697-5390",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Neurologic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carrie Knight, PT
• Evan Mae Llupar Lachica
• Lakeside RTC LLC (Lakeside Neurologic)
• Lakeside RTF LLC
• Lakeside SNF LLC
• Richard Leandro
• Larry Liedke
• Yanitt Grisel Lozada Perez, M.D.
• Elizabeth P Luzod, M.D.
• Apurba Manik, M.D.

• Rehabilitation Hospital in Wauchula, FL
• Providers in Wauchula, FL by specialty
• Rehabilitation Hospital in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; 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.