Grace Manor at Lake Morton, LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

Legal business name

GRACE MANOR AT LAKE MORTON, LLC

Practice address

610 E Lime Street
Lakeland, FL 33801

Phone

(863) 937-9114

Fax

(863) 937-9117

NPI assigned

Jun 7, 2013

Organization subpart

No

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

Authorized official

Name

Ms. Savitri Johnson

Title

Asst. Administrator

Phone

(863) 226-0358

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1370563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644969600000",
    "number": "1336587708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 ARIANA AVE",
            "city": "AUBURNDALE",
            "state": "FL",
            "postal_code": "338234139",
            "telephone_number": "863-226-0358",
            "fax_number": "863-875-9489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 E LIME STREET",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "33801",
            "telephone_number": "863-937-9114",
            "fax_number": "863-937-9117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE MANOR AT LAKE MORTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-07",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SAVITRI",
        "authorized_official_title_or_position": "ASST. ADMINISTRATOR",
        "authorized_official_telephone_number": "863-226-0358",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennie Carey Gossett, RD
• Jessica Goutzos
• Ankur Kumar Goyal, M.D., MSC
• Saachi Goyal, DDS
• Grace & Faith Care Agency LLC
• Grace Manor Suites
• David W Graham Jr., MD
• Maittee Grana
• Preetham Grandhi, M.D.
• Aitor Granero Lozano

• Alzheimer Center (Dementia Center) in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Alzheimer Center (Dementia Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.