Organization
SOUTHERN LIFESTYLE ALF OF LAKE PLACID LLC
Active
Other names
Southern Lifestyle
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES A OAKES (ADMINISTRATOR)
(863) 465-0568
Entity
Organization
Contact information
Practice address
1297 US 27 N, LAKE PLACID, FL 33852-7907
(863) 465-0568
(863) 465-0575
Mailing address
1297 US 27 N, LAKE PLACID, FL 33852-7907
(863) 465-0568
(863) 465-0575
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL11211
FL
311500000X
Alzheimer Center (Dementia Center)
AL11211
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000266800
MEDICAID WAIVER
FL
Enumeration date
02/13/2009
Last updated
02/13/2009
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