NPIMap

Organization Active NPI

Lubis Enterprise LLC

  • Assisted Living Facility
  • Leesburg, FL
National Provider Identifier
1972125136
Registry record updated May 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
LUBIS ENTERPRISE LLC
Practice address
1205 Bonaire Dr
Leesburg, FL 34748-5707
Phone
(352) 787-2573
NPI assigned
May 11, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2020

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

Authorized official

Name
Deviano Lubis
Title
Owner
Phone
(352) 787-3034

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

1205 Bonaire Dr
Leesburg, FL 34748-5707

Mailing address

1205 Bonaire Dr
Leesburg, FL 34748-5707

Other identifiers 1

IdentifierTypeStateIssuer
101111000MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Lubis Enterprise LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1972125136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 BONAIRE DR",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 BONAIRE DR",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485707",
            "telephone_number": "352-787-2573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUBIS ENTERPRISE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-11",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "LUBIS",
        "authorized_official_first_name": "DEVIANO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-787-3034"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101111000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Leesburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.