# GRACE MANOR AT LAKE MORTON, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336587708
- **Authorized official:** MS. SAVITRI JOHNSON (ASST. ADMINISTRATOR)
- **Authorized official phone:** (863) 226-0358

## Contact information

- **Practice address:** 610 E LIME STREET, LAKELAND, FL 33801
- **Practice address phone:** (863) 937-9114
- **Practice address fax:** (863) 937-9117
- **Mailing address:** 505 ARIANA AVE, AUBURNDALE, FL 33823-4139
- **Mailing address phone:** (863) 226-0358
- **Mailing address fax:** (863) 875-9489

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311500000X | Alzheimer Center (Dementia Center) | — | NULL | Yes |

## Other

- **Enumeration date:** 06/07/2013
- **Last updated:** 02/16/2022