Shady Lane Retirement Home

LBN: Shady Lane Retirement Home
Shady Lane Retirement Home is an health care organization with primary practice located at 201 Rosefield Ave , Leesburg FL 34748-5014. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Assisted Living Facility, which is considered as the primary health care specialty. Shady Lane Retirement Home can be contacted via phone (352) 728-1559, or through Lizardo, Segundo via phone (352) 728-1559.

Contact Information

Primary practice address
201 Rosefield Ave Leesburg FL 34748-5014
Phone: (352) 728-1559
Fax: (352) 728-1703
Website:
Map and Directions
Authorized official contact:
Name: Lizardo, Segundo
Phone: (352) 728-1559

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Assisted Living Facility 310400000X AL6001 Florida

Profile Details

NPI number 1114253754
LBN Legal business name Shady Lane Retirement Home
DBA Doing business as
Authorized official Lizardo, Segundo
Entity Organization
Organization subpart 1 No
Enumeration date Nov 1st, 2009
Last updated Nov 1st, 2009 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114253754 NPPES
Florida MEDICAID 2209282005070

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