Organization
1061 VIRGINIA STREET OPERATIONS LLC
Active
Other names
Lakeside Oaks Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH USSERY (VP)
(407) 571-1550
Entity
Organization
Contact information
Practice address
1061 VIRGINIA ST, DUNEDIN, FL 34698-7326
(727) 733-4189
(727) 734-7651
Mailing address
1061 VIRGINIA ST, DUNEDIN, FL 34698-7326
(727) 733-4189
(727) 734-7651
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF15100962
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006114000
—
FL
Enumeration date
12/22/2011
Last updated
11/27/2023
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