Lake City MGT LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF15510961 Issued in FL

Legal business name

LAKE CITY MGT LLC

Doing business as

Avalon Healthcare Center

Practice address

1270 SW Main Blvd
Lake City, FL 32025-6684

Phone

(386) 752-7900

Fax

(386) 752-8556

NPI assigned

Dec 2, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Lavern Patrick Herzog

Title

President

Phone

(386) 956-6956

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Avalon Healthcare Center Doing business as

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602115200000",
    "number": "1750365706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 SW MAIN BLVD",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320256684",
            "telephone_number": "386-752-7900",
            "fax_number": "386-752-8556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1270 SW MAIN BLVD",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320256684",
            "telephone_number": "386-752-7900",
            "fax_number": "386-752-8556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CITY MGT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-02",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A",
        "authorized_official_last_name": "HERZOG",
        "authorized_official_first_name": "LAVERN",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-956-6956",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF15510961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026162900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avalon Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avalon Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Lake City Medical Center Emergency Physicians, LLC
• Lake City Nursing LLC (The Palms Nursing and Rehab at Lake City)
• Lake City Operating Investments LLC (Bedrock Rehabilitation and Nursing Center at Lake City)
• Lake City Optical Co Inc (Eyeglass Express)
• Lake City Outpatient Anesthesia PLLC
• Lake City Outpatient Anesthesia PLLC

• Skilled Nursing Facility in Lake City, FL
• Providers in Lake City, 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 Oct 8, 2020; 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.