Organization
LAKESHORE MANOR AT LAKE JACKSON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOUIS F GARRARD V (OWNER)
(863) 226-0358
Entity
Organization
Contact information
Practice address
2397 US HIGHWAY 97 S, SEBRING, FL 33870
(813) 471-0772
Mailing address
505 ARIANA AVE, AUBURNDALE, FL 33823-4139
(863) 226-0358
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113392600
—
FL
Enumeration date
05/07/2021
Last updated
11/14/2022
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