Lakeside Pavilion

LBN: 2900 Twelfth Street North Llc
Lakeside Pavilion is an health care organization with primary practice located at 2900 12Th St N , Naples FL 34103-4528. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Skilled Nursing Facility, which is considered as the primary health care specialty. 2900 Twelfth Street North Llc can be contacted via phone (239) 261-2554, or through Berg, Michael Tennessee via phone (505) 468-4742.

Contact Information

Primary practice address
2900 12Th St N Naples FL 34103-4528
Phone: (239) 261-2554
Fax: (239) 261-4540
Website:
Map and Directions
Authorized official contact:
Name: Berg, Michael Tennessee
Phone: (505) 468-4742

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Skilled Nursing Facility 314000000X SNF 12840962 Florida

Profile Details

NPI number 1275556383
LBN Legal business name 2900 Twelfth Street North Llc
DBA Doing business as Lakeside Pavilion
Authorized official Berg, Michael Tennessee
Entity Organization
Organization subpart 1 Yes
Enumeration date Jul 26th, 2006
Last updated Jan 4th, 2016 - about 10 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 1275556383 NPPES
Florida MEDICAID 025684600

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