Organization
LISENBY LLLP
Active
Other names
Lisenby on Lake Caroline
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH H. SCHULTZ (PRESIDENT)
(407) 645-3211
Entity
Organization
Contact information
Practice address
1400 WEST ELEVENTH STREET, PANAMA CITY, FL 32401-1896
(850) 785-6121
(850) 747-3696
Mailing address
1890 STATE ROAD 436, SUITE 300, WINTER PARK, FL 32792-2285
(407) 645-3211
(407) 628-2853
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1296096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020398000
—
FL
Enumeration date
09/08/2006
Last updated
06/02/2014
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