Organization
CONWAY LAKES NC, LLC
Active
Other names
Conway Lakes Health & Rehab Center, Conway Lakes Health & Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL B KELLETT (AS SOLE MEMBER OF SBK CAPITAL LLC)
(404) 250-1846
Entity
Organization
Contact information
Practice address
5201 CURRY FORD RD, ORLANDO, FL 32812-8741
(407) 384-8838
(407) 384-7936
Mailing address
5201 CURRY FORD RD, ORLANDO, FL 32812-8741
(407) 384-8838
(407) 384-7936
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF11020963
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026451200
—
FL
01
—
V673P-5339
VA
—
Enumeration date
09/29/2005
Last updated
02/14/2022
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