Organization
LAKE CITY NURSING AND REHABILITATION CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NORBERT A BENNETT (CO-CEO)
(716) 662-4955
Entity
Organization
Contact information
Practice address
2055 REX RD, LAKE CITY, GA 30260-3944
(404) 361-5114
(404) 363-6366
Mailing address
PO BOX 428, ORCHARD PARK, NY 14127-0428
(716) 662-4955
(716) 667-9230
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
10311849
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00141699A
—
GA
Enumeration date
08/29/2006
Last updated
12/08/2023
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