Organization
LAKE GIBSON VILLAGE,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE TUCKER (CHIEF EXECUTIVE OFFICER)
(850) 766-3712
Entity
Organization
Contact information
Practice address
771 CARPENTERS WAY, LAKELAND, FL 33809-3922
(850) 766-3712
Mailing address
771 CARPENTERS WAY, LAKELAND, FL 33809-3922
(850) 766-3712
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
13081
FL
Other
Enumeration date
05/09/2018
Last updated
05/09/2018
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