Active NPI
Lake Centre Home Care, LLC
- Home Health Agency
- Leesburg, FL
National Provider Identifier
1649209537
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 299992424
- Legal business name
- LAKE CENTRE HOME CARE, LLC
- Practice address
- 310 Market St
Leesburg, FL 34748-5135 - Phone
- (352) 315-0050
- Fax
- (352) 315-0059
- NPI assigned
- Jul 2, 2006
- Last updated
- Mar 1, 2022
- 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
- Ms. Lori Davis, MBA
- Title
- Coo
- Phone
- (352) 315-0050
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 299992424 | FL | Primary |
Addresses
Primary practice location
310 Market St
Leesburg, FL 34748-5135
Mailing address
310 Market St
Leesburg, FL 34748-5135
Phone (352) 315-0050
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 299992424 | Other | FL | HOME HEALTH AGENCY LICENS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061206000046 | FL | Part A Provider - Home Health Agency | 6406859396 | Practice locations: Leesburg, FL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1649209537. Details of each certification follow.
Home health agency certification: CCN 108416
- Legal name
- LAKE CENTRE HOME CARE, LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- May 11, 2007
- Last certification
- Aug 26, 2020
- Ownership / control type
- Proprietary
- Organization structure
- LLC
- Enrollment address
- 310 Market St
Leesburg, FL 34748-5135
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Lake Centre Home Care, LLC
- Overall star rating
- Ownership
- Proprietary
- Certified
- May 11, 2007
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider DirectoryLocations
310 Market St
Leesburg, FL 34748
Phone (352) 315-0050
600 W North Blvd
Leesburg, FL 34748
Phone (352) 728-6636
711 N 3rd St
Ste 1
Leesburg, FL 34748
Phone (352) 315-0050
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Ownership & related parties
All disclosed owners & managing parties 5
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Shayna Grunewald | Corporate Director | Dec 1, 2018 | 75% |
| W-2 Managing Employee | Nov 29, 2018 | 100% | |
| Shelly Morgan | 5% Or Greater Indirect Ownership Interest | Jan 1, 2017 | 50% |
| Sidney Morgan | 5% Or Greater Indirect Ownership Interest | Jan 1, 2017 | 50% |
| Corporate Director | Jan 1, 2017 | 25% | |
| Lori Davis | Corporate Officer | Sep 20, 2021 | |
| Active Home Health Solutions LLC | 5% Or Greater Direct Ownership Interest | Jan 1, 2017 | 100% |
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Registered Respiratory Therapist
- Leesburg, FL
- NPI 1548392525
-
- Physical Therapist
- Leesburg, FL
- NPI 1912126541
Affiliated clinicians 7
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Internal Medicine Physician
- Mount Dora, FL
- NPI 1629279344
Home health agency
-
- Internal Medicine Physician
- Summerfield, FL
- NPI 1922079508
Home health agency
-
- Orthopaedic Surgery Physician
- Mount Dora, FL
- NPI 1275529455
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151798400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1646092800000",
"number": "1649209537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 MARKET ST",
"city": "LEESBURG",
"state": "FL",
"postal_code": "347485135",
"telephone_number": "352-315-0050",
"fax_number": "352-315-0059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 MARKET ST",
"city": "LEESBURG",
"state": "FL",
"postal_code": "347485135",
"telephone_number": "352-315-0050",
"fax_number": "352-315-0059"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAKE CENTRE HOME CARE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-02",
"last_updated": "2022-03-01",
"certification_date": "2022-03-01",
"status": "A",
"authorized_official_last_name": "DAVIS",
"authorized_official_first_name": "LORI",
"authorized_official_title_or_position": "COO",
"authorized_official_telephone_number": "352-315-0050",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "MBA"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "FL",
"license": "299992424",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HOME HEALTH AGENCY LICENS",
"identifier": "299992424",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Leesburg, FL
- Lake Arthritis Center P a
- Lake Cancer & Hematology PA
- Lake Cancer Medical Center PA
- Lake Center of H.O.P.E., PA
- Lake Centre Home Care LLC
- Lake County Anesthesia Associates PA
- Lake County Neurology, PA
- Lake County Neurosurgicaland Spinal Institute (Michael G Hill MD PA)
- Lake ENT & FPS, PA (Lake Ear, Nose Throat and Facial Plastic Surgery Associates)
- Lake Foot and Ankle PA (Lakeside Foot and Ankle Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.