NPIMap

Organization Active NPI

Florida Department of Veterans Affairs

  • Alzheimer Center (Dementia Center)
  • Land O Lakes, FL
National Provider Identifier
1316939804
Registry record updated Jul 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Alzheimer Center (Dementia Center)Taxonomy code 311500000X
License
SNF130470999 Issued in FL
Legal business name
FLORIDA DEPARTMENT OF VETERANS AFFAIRS
Practice address
6919 Parkway Blvd
Land O Lakes, FL 34639-2909
Phone
(727) 518-3202
NPI assigned
Aug 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2026

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

Authorized official

Name
Mr. William G Puckett
Title
Program Director
Phone
(727) 518-3202

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Alzheimer Center (Dementia Center) 311500000X SNF130470999 FL Primary
Skilled Nursing Facility 314000000X SNF130470999 FL

Addresses

Primary practice location

6919 Parkway Blvd
Land O Lakes, FL 34639-2909

Mailing address

6919 Parkway Blvd
Land O Lakes, FL 34639-2909
Phone (813) 558-5000

Other identifiers 1

IdentifierTypeStateIssuer
021491400MedicaidFL

Other names 1

  • Baldomero Lopez State Veterans Nursing Home Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120326000647 FL Part A Provider - Skilled Nursing Facility 5698686608 Practice locations: Land O Lakes, FL

Skilled nursing facility certification: CCN 106006

Legal name
FLORIDA DEPARTMENT OF VETERANS AFFAIRS
Doing business as
BALDERMO LOPEZ STATE VETERANS' NURSING HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 7, 1999
Last certification
Jan 25, 2024
Beds
120
Ownership / control type
State
Multi-facility organization
Florida Department of Veterans Affairs
Organization structure
OtherNon-profit
Incorporated
in FL
Enrollment address
6919 Parkway Blvd
Land O Lakes, FL 34639-2909
Nursing home name
BALDOMERO LOPEZ MEMORIAL VETERANS NURSING HOME
Affiliated entity
FLORIDA DEPARTMENT OF VETERANS' AFFAIRS

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Baldomero Lopez Memorial Veterans Nursing HomeCCN 106006
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Government - State
Certified
May 7, 1999
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120113.9 residents per day on average
Chain
Florida Department of Veterans' Affairs7 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Florida Department of Veterans Affairs12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joshua Star Firebaugh Individual Operational/Managerial Control Jun 2, 2024
Vincent J Dilella Individual Adp of the SNF Jan 28, 2025
Florida Department of Veterans Affairs Organization, Land O Lakes, FL Medical provider/supplier 5% Or Greater Direct Ownership Interest Jan 1, 1999 100%
Alfred Carter Individual Corporate DirectorChief of Staff Jan 1, 1999 100%
Marlies Sarrett Individual Operational/Managerial Control Jan 1, 2014
Adp of the SNF Jan 28, 2025

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Emory L. Bennett State Veterans' Nursing HomeDaytona Beach, FL, CCN 105840 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Nov 18, 2014
Clyde E Lassen State Veterans Nursing HomeSt Augustine, FL, CCN 106088 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2010
Douglas Jacobson State Veterans' Nursing HomePort Charlotte, FL, CCN 106059 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2004
Clifford Chester Sims State Veterans' Nursing HomePanama City, FL, CCN 106056 Skilled nursing facility Direct Ownership Interest (100%) Aug 1, 2003
Florida Department of Veterans AffairsPort St Lucie, FL, CCN 686128 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 30, 2022
Florida Department of Veterans AffairsOrlando, FL, CCN 106151 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2023

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783468800000",
    "number": "1316939804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6919 PARKWAY BLVD",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346392909",
            "telephone_number": "813-558-5000",
            "fax_number": "813-558-5021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6919 PARKWAY BLVD",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346392909",
            "telephone_number": "727-518-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA DEPARTMENT OF VETERANS AFFAIRS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-19",
        "last_updated": "2026-07-08",
        "certification_date": "2026-07-08",
        "status": "A",
        "authorized_official_last_name": "PUCKETT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "727-518-3202",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "FL",
            "license": "SNF130470999",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF130470999",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021491400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baldomero Lopez State Veterans Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Baldomero Lopez State Veterans Nursing Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Land O Lakes, FL

Sources for this page

Verify at the official NPI Registry.