Organization
BVM LAKESHORE LLC,
Active
Other names
Renaissance Village
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT L RYNARD SR. (CHAIRMAN / PRESIDENT)
(317) 627-0504
Entity
Organization
Contact information
Practice address
16001 LAKESHORE VILLA DRIVE, TAMPA, FL 33613
(813) 968-5093
(813) 968-5093
Mailing address
PO BOX 501188, INDIANAPOLIS, IN 46250
(317) 806-6771
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL7531
FL
314000000X
Skilled Nursing Facility
1282096
FL
Other
Enumeration date
11/14/2013
Last updated
11/14/2013
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