Organization
LL, FORT MYERS, LLC
Active
Other names
Lamplight Inn of Fort Myers
Organization subpart
No
Provider details
NPI number
Authorized official
BOBBY PETRAS (COO)
(260) 797-9482
Entity
Organization
Contact information
Practice address
1896 PARK MEADOWS DR, FORT MYERS, FL 33907-3738
(239) 939-5421
Mailing address
7444 LONG AVE, SKOKIE, IL 60077-3214
(847) 329-4100
(847) 329-4900
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL5096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL5096
RESIDENTIAL CARE FACILITY LICENSE
FL
Enumeration date
02/11/2014
Last updated
02/11/2014
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