Organization
15204 WEST COLONIAL DRIVE OPERATIONS LLC
Active
Other names
Colonial Lakes Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH USSERY (VP)
(407) 571-1550
Entity
Organization
Contact information
Practice address
15204 W COLONIAL DR, WINTER GARDEN, FL 34787-6042
(407) 877-2394
(407) 877-6143
Mailing address
15204 W COLONIAL DR, WINTER GARDEN, FL 34787-6042
(407) 877-2394
(407) 877-6143
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
SNF1610096
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004385400
—
FL
Enumeration date
12/22/2011
Last updated
11/27/2023
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