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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