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Organization

16001 LAKESHORE VILLA DRIVE OPCO LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RUSSELL SIMON (AUTHORIZED OFFICIAL)
(419) 247-2800
Entity
Organization

Contact information

Practice address
16001 LAKESHORE VILLA DR, TAMPA, FL 33613-1336
(813) 386-1145
Mailing address
4500 DORR ST, TOLEDO, OH 43615-4040
(419) 247-2800

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary

Other

Enumeration date
10/23/2025
Last updated
10/23/2025
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