LL, Fort Myers, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL5096 Issued in FL

Legal business name

LL, FORT MYERS, LLC

Doing business as

Lamplight Inn of Fort Myers

Practice address

1896 Park Meadows Dr
Fort Myers, FL 33907-3738

Phone

(239) 939-5421

NPI assigned

Feb 11, 2014

Organization subpart

No

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

Authorized official

Name

Bobby Petras

Title

Coo

Phone

(260) 797-9482

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lamplight Inn of Fort Myers Doing business as

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

{
    "created_epoch": "1392076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392076800000",
    "number": "1407270432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7444 LONG AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600773214",
            "telephone_number": "847-329-4100",
            "fax_number": "847-329-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1896 PARK MEADOWS DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073738",
            "telephone_number": "239-939-5421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LL, FORT MYERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-11",
        "last_updated": "2014-02-11",
        "status": "A",
        "authorized_official_last_name": "PETRAS",
        "authorized_official_first_name": "BOBBY",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "260-797-9482"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL5096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RESIDENTIAL CARE FACILITY LICENSE",
            "identifier": "AL5096",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lamplight Inn of Fort Myers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Fort Myers, FL
• Providers in Fort Myers, 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 11, 2014; 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.