Lake Wales SLC Opco LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

LAKE WALES SLC OPCO LLC

Doing business as

The Club at Lakes Wales

Practice address

12 E Grove Ave
Lake Wales, FL 33853-4760

Phone

(863) 679-8146

Fax

(863) 422-0267

NPI assigned

May 20, 2022

Last updated

Feb 27, 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

Mrs. Pilar Carvajal

Title

Ceo

Phone

(305) 428-2480

Specialties & licenses 1

Addresses

Other names 1

• The Club at Lakes Wales Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1653004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677456000000",
    "number": "1396482329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "941 W MORSE BLVD STE 100",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327893781",
            "telephone_number": "305-428-2480",
            "fax_number": "305-428-2480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 E GROVE AVE",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534760",
            "telephone_number": "863-679-8146",
            "fax_number": "863-422-0267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE WALES SLC OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-20",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A",
        "authorized_official_last_name": "CARVAJAL",
        "authorized_official_first_name": "PILAR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "305-428-2480",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pcarvajal@islcommunities.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "address_1": "12 E Grove Ave",
            "city": "Lake Wales",
            "state": "FL",
            "country_code": "US",
            "postal_code": "338534760",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Club at Lakes Wales",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Club at Lakes Wales",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Lake Wales Medical Walk in Clinic PA
• Lake Wales Operating Group LLC
• Lake Wales Physician Services, LLC
• Lake Wales Primary Care Center, LLC
• Lake Wales SNF LLC
• Lake Wales Transit LLC
• Lake Wales Urology, LLC
• Lakeland Regional Health System, Inc
• Junaid Anis Lakhani

• Assisted Living Facility in Lake Wales, FL
• Providers in Lake Wales, 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 Feb 27, 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.