CTK Properties, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL7959 Issued in FL

Legal business name

CTK PROPERTIES, LLC

Doing business as

Kiva of Mount Dora

Practice address

505 E 9TH Ave
Mount Dora, FL 32757-4937

Phone

(352) 383-5005

NPI assigned

Jun 24, 2013

Last updated

Jun 24, 2013By 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

Mr. Kelly D Lucas

Title

Managing Partner

Phone

(352) 383-5005

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kiva of Mount Dora Doing business as

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

{
    "created_epoch": "1372032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372032000000",
    "number": "1326487281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 E 9TH AVE",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327574937",
            "telephone_number": "352-383-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 E 9TH AVE",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327574937",
            "telephone_number": "352-383-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CTK PROPERTIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-24",
        "last_updated": "2013-06-24",
        "status": "A",
        "authorized_official_last_name": "LUCAS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "352-383-5005",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL7959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "689402000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kiva of Mount Dora",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Stephanie R Cummings
• Alexis Taylor Cunha, RBT
• Amy Cunningham

• Assisted Living Facility in Mount Dora, FL
• Providers in Mount Dora, 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 Jun 24, 2013; 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.