| NPI | 1821006701 |
|---|---|
| Doing Business As | LAKESHORE VILLA |
| Entity Type | Organization |
| Authorized Contact | RONALD MILLINER Executive Director 813-968-5093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: FL 1282096) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2020-08-22 |