NPIMap

Organization Active NPI

Nic 5 Lake Morton Plaza Leasing LLC

Doing business as Lake Morton Plaza

  • Assisted Living Facility
  • Lakeland, FL
National Provider Identifier
1801230206
Registry record updated Nov 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
5308 Issued in FL
Legal business name
NIC 5 LAKE MORTON PLAZA LEASING LLC
Doing business as
Lake Morton Plaza
Practice address
400 S Florida Ave
Lakeland, FL 33801
Phone
(863) 683-1000
Fax
(863) 682-7854
NPI assigned
Apr 29, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2016

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

Authorized official

Name
Ms. Jane Ryu
Title
President/Ceo/Cfo
Phone
(212) 479-5270

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 5308 FL Primary

Addresses

Primary practice location

400 S Florida Ave
Lakeland, FL 33801

Mailing address

PO Box 1700 C/O Holiday Retirement
Nic 5 Lake Morton Plaza Leasing LLC
Lake Oswego, OR 97035
Phone (971) 245-8020

Other names 1

  • Lake Morton Plaza Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1367193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480464000000",
    "number": "1801230206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1700 C/O HOLIDAY RETIREMENT",
            "address_2": "NIC 5 LAKE MORTON PLAZA LEASING LLC",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "97035",
            "telephone_number": "971-245-8020",
            "fax_number": "503-431-2295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S FLORIDA AVE",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "33801",
            "telephone_number": "863-683-1000",
            "fax_number": "863-682-7854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIC 5 LAKE MORTON PLAZA LEASING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-29",
        "last_updated": "2016-11-30",
        "status": "A",
        "authorized_official_last_name": "RYU",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "PRESIDENT/CEO/CFO",
        "authorized_official_telephone_number": "212-479-5270",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "5308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Morton Plaza",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; 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.