Organization
LAKE CITY MGT LLC
Active
Other names
Avalon Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAVERN PATRICK HERZOG (PRESIDENT)
(386) 956-6956
Entity
Organization
Contact information
Practice address
1270 SW MAIN BLVD, LAKE CITY, FL 32025-6684
(386) 752-7900
(386) 752-8556
Mailing address
1270 SW MAIN BLVD, LAKE CITY, FL 32025-6684
(386) 752-7900
(386) 752-8556
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF15510961
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026162900
—
FL
Enumeration date
12/02/2005
Last updated
10/08/2020
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