Vista Lake MC LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

VISTA LAKE MC LLC

Practice address

710 S Lake St
Leesburg, FL 34748-7327

Phone

(352) 728-6661

NPI assigned

Oct 6, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Shlomo Greenstein

Title

Managing Director

Phone

(727) 697-9920

Specialties & licenses 1

Addresses

Other names 1

• Vista Lake Memory Care Doing business as

Locations

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

{
    "created_epoch": "1665014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1609591197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3012 AVENUE J FL 2",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112103838",
            "telephone_number": "727-697-9920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 S LAKE ST",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347487327",
            "telephone_number": "352-728-6661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTA LAKE MC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-06",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "GREENSTEIN",
        "authorized_official_first_name": "SHLOMO",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "727-697-9920",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vista Lake Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Leesburg, FL
• Providers in Leesburg, 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 Oct 6, 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.