PCP Lakeshore Drive Opco LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PCP LAKESHORE DRIVE OPCO LLC

Practice address

2516 Lakeshore Dr
Tallahassee, FL 32312-2104

Phone

(850) 616-6253

NPI assigned

Jul 26, 2023

Last updated

Jul 26, 2023By 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

Seth Walker

Title

Cfo, Srim

Phone

(850) 583-7990

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1690329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690329600000",
    "number": "1164103883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2573 BARRINGTON CIR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323086805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2516 LAKESHORE DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323122104",
            "telephone_number": "850-616-6253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PCP LAKESHORE DRIVE OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-26",
        "last_updated": "2023-07-26",
        "certification_date": "2023-07-26",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "SETH",
        "authorized_official_title_or_position": "CFO, SRIM",
        "authorized_official_telephone_number": "850-583-7990"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Payne Bruce, LMHC
• Erica Michelle Payne
• John Levi Payne
• Kaylah Payne
• Jai Paytee, PA-C
• Mitchell Ford Peabody, D.O.
• Peace Haven
• Leisa Reid Peach, LMT
• Joseph Paul Peacock, RPH
• Tarvis Peacock, MD

• Assisted Living Facility in Tallahassee, FL
• Providers in Tallahassee, 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 Jul 26, 2023; 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.