Lake Wales Healthcare LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF12760961 Issued in FL

Legal business name

LAKE WALES HEALTHCARE LLC

Doing business as

Grace Healthcare of Lake Wales

Practice address

730 N Scenic Hwy
Lake Wales, FL 33853-3208

Phone

(863) 676-1512

NPI assigned

Feb 1, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Alice Marie Clark Danks, CPA

Title

VP of Finance

Phone

(423) 308-1845

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Grace Healthcare of Lake Wales Doing business as

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

{
    "created_epoch": "1296518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296518400000",
    "number": "1700182235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 N SCENIC HWY",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338533208",
            "telephone_number": "863-676-1512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 N SCENIC HWY",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338533208",
            "telephone_number": "863-676-1512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE WALES HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-01",
        "last_updated": "2011-02-01",
        "status": "A",
        "authorized_official_last_name": "CLARK DANKS",
        "authorized_official_first_name": "ALICE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "423-308-1845",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF12760961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031934100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grace Healthcare of Lake Wales",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lake Wales Chiropractic Center Inc
• Lake Wales Clinic Corp
• Lake Wales Dental Associates
• Lake Wales Emergency Physicians, LLC
• Lake Wales Foot and Ankle Care, Inc
• Lake Wales Hospital Corporation (Lake Wales Medical Center)
• Lake Wales Hospital Corporation (Lake Wales Medical Center)
• Lake Wales Medial Center
• Lake Wales Medical Imaging Center One, Inc
• Lake Wales Medical Walk in Clinic PA

• Skilled Nursing Facility in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 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.