Organization
PCP LADY LAKE OPCO LLC
Active
Other names
VILLAGE VERANDA AT LADY LAKE
Organization subpart
No
Provider details
NPI number
Authorized official
SETH WALKER (CFO)
(850) 583-7990
Entity
Organization
Contact information
Practice address
955 S US HIGHWAY 441, LADY LAKE, FL 32159
(352) 268-3523
Mailing address
2573 BARRINGTON CIR, TALLAHASSEE, FL 32308-6805
(850) 583-7990
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11969543
AHCA
FL
Enumeration date
10/30/2025
Last updated
10/30/2025
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