Active NPI
South Lake Hospital, Inc.
- Home Health Agency
- Clermont, FL
National Provider Identifier
1609877976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- HHA210740962
- Legal business name
- SOUTH LAKE HOSPITAL, INC.
- Practice address
- 1120 Citrus Tower Blvd
Ste 110
Clermont, FL 34711-1909 - Phone
- (352) 241-7138
- Fax
- (352) 241-7248
- NPI assigned
- Aug 9, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kathleen Schlachter
- Title
- Director of Nursing
- Phone
- (352) 241-7138
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | HHA210740962 | FL | Primary |
Addresses
Primary practice location
1120 Citrus Tower Blvd
Ste 110
Clermont, FL 34711-1909
Mailing address
1920 Don Wickham Drive
Ste 110
Clermont, FL 34711
Phone (352) 241-7138
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 650128100 | Medicaid | FL | |
| J5Y | Other | FL | BCBS |
Other names 1
- South Lake Home Health
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Change-of-ownership history 1
Medicare enrollment files| Date | Event | Counterparty |
|---|---|---|
| Aug 1, 2020 | Change of Ownership | Mederi Caretenders |
National Provider Directory
National Provider DirectoryChange of ownership 1
Medicare changes of ownership in which this facility was the buyer or the seller.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123545600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1273622400000",
"number": "1609877976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1920 DON WICKHAM DRIVE",
"address_2": "STE 110",
"city": "CLERMONT",
"state": "FL",
"postal_code": "34711",
"telephone_number": "352-241-7138",
"fax_number": "352-241-7248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 CITRUS TOWER BLVD",
"address_2": "STE 110",
"city": "CLERMONT",
"state": "FL",
"postal_code": "347111909",
"telephone_number": "352-241-7138",
"fax_number": "352-241-7248"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTH LAKE HOSPITAL, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2005-08-09",
"last_updated": "2010-05-12",
"status": "A",
"authorized_official_last_name": "SCHLACHTER",
"authorized_official_first_name": "KATHLEEN",
"authorized_official_title_or_position": "DIRECTOR OF NURSING",
"authorized_official_telephone_number": "352-241-7138"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "FL",
"license": "HHA210740962",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "650128100",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "J5Y",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "South Lake Home Health",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Clermont, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.