Organization
SPRING LAKE NC, LLC
Active
Other names
Spring Lake Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL B. KELLETT (AS SOLE MEMBER OF SBK CAPITAL LLC)
(404) 233-7048
Entity
Organization
Contact information
Practice address
1540 6TH ST NW, WINTER HAVEN, FL 33881-2368
(863) 294-3055
(863) 294-4210
Mailing address
1540 6TH ST NW, WINTER HAVEN, FL 33881-2368
(863) 294-3055
(863) 294-4210
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF15110961
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026457100
—
FL
01
—
V673P-5338
VA
—
Enumeration date
09/29/2005
Last updated
07/29/2014
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