Organization
KAN LAKE CORPORATION INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAMLAWATY LAKRAM CORE (ADMINISTRATOR)
(772) 519-4327
Entity
Organization
Contact information
Practice address
308 S 30TH ST, FORT PIERCE, FL 34947-7205
(772) 519-4327
Mailing address
308 S 30TH ST, FORT PIERCE, FL 34947-7205
(772) 519-4327
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
AL9025
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141943900
—
FL
Enumeration date
05/26/2011
Last updated
05/26/2011
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