Lakeshore Manor at Lake Jackson LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

LAKESHORE MANOR AT LAKE JACKSON LLC

Practice address

2397 US Highway 97 S
Sebring, FL 33870

Phone

(813) 471-0772

NPI assigned

May 7, 2021

Last updated

Nov 14, 2022By 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

Louis F Garrard V

Title

Owner

Phone

(863) 226-0358

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1620345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668384000000",
    "number": "1588248322",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2397 US HIGHWAY 97 S",
            "city": "SEBRING",
            "state": "FL",
            "postal_code": "33870",
            "telephone_number": "813-471-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE MANOR AT LAKE JACKSON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-07",
        "last_updated": "2022-11-14",
        "certification_date": "2022-11-14",
        "status": "A",
        "authorized_official_last_name": "GARRARD",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "863-226-0358",
        "authorized_official_name_suffix": "V"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113392600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas C. Lackey II, D. O.
• Jeff Irwin Ladinsky, PT
• Susie Lorevi Imperio Lagabon, RPH
• Lake Jackson Emergency Physicians LLC
• Lake Placid Chiropractic Clinic, Inc
• Lakeside Dermatology LLC
• Lakeview Idd Therapy Center P.a.
• Lakeview Occupational and Industrial Clinic Dba a Plus Occupational an (A Plus Occupational and Industrial Rehabilitation Center)
• Lakeview Occupational and Industrial Clinic, P.a.
• Lakeview Orthopaedic and Hand Center, P.a.

• Assisted Living Facility in Sebring, FL
• Providers in Sebring, 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 Nov 14, 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.