Organization
SHADY LANE RETIREMENT HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SEGUNDO LIZARDO (OWNER/ADMINISTRATOR)
(352) 728-1559
Entity
Organization
Contact information
Practice address
201 ROSEFIELD AVE, LEESBURG, FL 34748-5014
(352) 728-1559
(352) 728-1703
Mailing address
201 ROSEFIELD AVE, LEESBURG, FL 34748-5014
(352) 728-1559
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL6001
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2209282005070
—
FL
Enumeration date
11/01/2009
Last updated
11/01/2009
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