Organization
LAKESIDE SNF LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANEESH BANSAL MD (CEO)
(800) 697-5390
Entity
Organization
Contact information
Practice address
1962 VANDOLAH RD, WAUCHULA, FL 33873-8726
(800) 697-5390
Mailing address
1962 VANDOLAH RD, WAUCHULA, FL 33873-8726
(863) 773-2857
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
11/04/2020
Last updated
04/14/2021
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