Organization
SF III TLF, LLC
Active
Other names
FINR, LAKESIDE NEUROLOGIC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELIZABETH CHOQUETTE (COLLECTIONS MANAGER)
(863) 767-4484
Entity
Organization
Contact information
Practice address
1962 VANDOLAH ROAD, WAUCHULA, FL 33873
(863) 773-2857
(863) 773-2041
Mailing address
PO BOX 1348, WAUCHULA, FL 33873-1348
(863) 773-2857
(863) 773-2041
Taxonomy
Speciality
Code
Description
License number
State
283X00000X
Rehabilitation Hospital
Primary
TLF7006096
FL
283X00000X
Rehabilitation Hospital
TLF70090971
FL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
TLF7006096
FL
320700000X
Physical Disabilities Residential Treatment Facility
TLF7006096
FL
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
100045445
FL
Other
Enumeration date
09/20/2006
Last updated
06/02/2020
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