Organization
LAKESIDE MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN K GRANADOS (MBR/BGR)
(727) 798-2497
Entity
Organization
Contact information
Practice address
676 UNION ST, DUNEDIN, FL 34698-8424
(727) 798-2497
(727) 736-8642
Mailing address
676 UNION ST, DUNEDIN, FL 34698-8424
(727) 798-2497
(727) 736-8642
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL8358
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
690391600
—
FL
Enumeration date
02/06/2014
Last updated
02/06/2014
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