Kan Lake Corporation Inc.

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

AL9025 Issued in FL

Legal business name

KAN LAKE CORPORATION INC.

Practice address

308 S 30TH St
Fort Pierce, FL 34947-7205

Phone

(772) 519-4327

NPI assigned

May 26, 2011

Organization subpart

No

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

Authorized official

Name

Kamlawaty Lakram, CORE

Title

Administrator

Phone

(772) 519-4327

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1306368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306368000000",
    "number": "1477846129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 S 30TH ST",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349477205",
            "telephone_number": "772-519-4327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 S 30TH ST",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349477205",
            "telephone_number": "772-519-4327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAN LAKE CORPORATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-26",
        "last_updated": "2011-05-26",
        "status": "A",
        "authorized_official_last_name": "LAKRAM",
        "authorized_official_first_name": "KAMLAWATY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "772-519-4327",
        "authorized_official_credential": "CORE"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "FL",
            "license": "AL9025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "141943900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Judah in Home Support Care Inc
• Just Ladies Healthcare, P.a.
• Justranzit School Bus Inc
• Alexandra C Kaiser, MS
• Dana Kajan, DO
• Jeffrey W Kanski, M.D.
• Donald Orji Kanu, MD, DO
• Sapir Zahava Karli Micha, M.D.
• Joseph Joseph Katta, MD
• Michelle Marie Kee-Smith, CRT

• Assisted Living Facility (Mental Illness) in Fort Pierce, FL
• Providers in Fort Pierce, FL by specialty
• Assisted Living Facility (Mental Illness) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2011; 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.