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Organization
SCG LAKE COUNTRY LLC
Active
Organization
SCG LAKE COUNTRY LLC
Active
Other names
Lake Country Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT DANIEL VAUGHAN (PRESIDENT)
(813) 341-2700
Entity
Organization
Contact information
Practice address
401 C E COLSTON DR, MARIETTA, OK 73448-1230
(580) 276-3318
(580) 276-2100
Mailing address
1240 MARBELLA PLAZA DR., TAMPA, FL 33619-7905
(813) 341-2700
(813) 676-0127
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH4301-4301
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100776270A
—
OK
Enumeration date
08/09/2005
Last updated
01/22/2010
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