Organization
LUBIS ENTERPRISE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEVIANO LUBIS (OWNER)
(352) 787-3034
Entity
Organization
Contact information
Practice address
36321 GRAYS AIRPORT RD, FRUITLAND PARK, FL 34731-5418
(352) 460-0754
Mailing address
36321 GRAYS AIRPORT RD, FRUITLAND PARK, FL 34731-5418
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105612100
—
FL
Enumeration date
05/11/2020
Last updated
05/11/2020
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