Organization
BELLA VIDA AT LAKE FOREST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PENNY BROWNELL (ADMINISTRATOR)
(352) 431-5159
Entity
Organization
Contact information
Practice address
4055 LAKE FOREST ST, MOUNT DORA, FL 32757-5211
(352) 269-3779
(321) 256-5193
Mailing address
7901 4TH ST N STE 300, ST PETERSBURG, FL 33702-4399
(352) 269-3779
(321) 256-5193
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
08/26/2022
Last updated
08/26/2022
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