SUMMERVILLE AT LAKELAND, LLC (NPI# 1518176346) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518176346 |
| Entity Type | Organization |
| Organization Name | SUMMERVILLE AT LAKELAND, LLC |
| Other Organization Name | BROOKDALE LAKELAND HILLS |
| Practice Address |
2111 Lakeland Hills Blvd. Brookdale Lakeland Hills Lakeland FL 33803 |
| Mailing Address |
6737 W Washington St Suite 2300, Attn: Ar Medicaid Milwaukee WI 53214 |
| Practice Telephone | 8636881126 |
| Practice Fax Number | 8636836800 |
| Mailing Telephone | 2062982909 |
| Mailing Fax Number | 2063014500 |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2015-03-13 |
| Authorized Official Name | MARK OHLENDORF (PRESIDENT/CEO) |
| Authorized Official Telephone | 4149185403 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 311500000X | Alzheimer Center (Dementia Center) | AL6107 | FL | Nursing & Custodial Care Facilities |
| Y | 310400000X | Assisted Living Facility | AL6107 | FL | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Brookdale Lakeland Hills | Doing Business As Name - Organization |
| Street Address |
2111 LAKELAND HILLS BLVD. BROOKDALE LAKELAND HILLS |
| City | LAKELAND |
| State | FL |
| Zip Code | 33803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861964819 | Steven P Agelidis | Counselor | 2020 S. Florida Ave, Suite 207, Lakeland, FL 33803 | 2018-12-31 |
| 1902316201 | Kesara Mai Ngam | Massage Therapist | 117 West Oak Drive, Lakeland, FL 33803 | 2017-10-02 |
| 1396260618 | Suncoast Behavioral Solutions, LLC | Behavioral Analyst | 1920 E Edgewood Dr Apt A8, Lakeland, FL 33803 | 2017-08-08 |
| 1316484413 | Daniel Jacob Stahl | Behavior Technician | 145 East Edgewood Drive, Lakeland, FL 33803 | 2017-01-26 |
| 1780037002 | Shelley Stettinius | Behavioral Analyst | 145 East Edgewood Dr, Lakeland, FL 33803 | 2016-07-21 |
| 1396106654 | Highlands Occupational Therapy, Inc | Occupational Therapist | 2000 East Edgewood Drive, Suite 114, Lakeland, FL 33803 | 2016-03-15 |
| 1003289570 | Jayna Dinsmore | Physical Therapy Assistant | 321 Imperial Blvd, D38, Lakeland, FL 33803 | 2015-11-05 |
| 1093187429 | Healthstat Wellness Polk-lakeland | Preventive Medicine | 3215 Winter Lake Road, Lakeland, FL 33803 | 2015-10-26 |
| 1962812545 | Florida Presbyterian Homes, Inc | Nursing Facility/Intermediate Care Facility | 901 Lakeside Avenue, Lakeland, FL 33803 | 2014-05-05 |
| 1710316336 | Trinity Endodontics | Health Maintenance Organization | 1602 S. Florida Ave, Ste #1, Lakeland, FL 33803 | 2013-11-04 |
| Find all providers in zip 33803 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831798289 | Siloam Health Care Services | Assisted Living Facility | 1205 Neville Ave, Lakeland, FL 33805-4144 | 2020-10-17 |
| 1841709847 | Senior Living Properties Iv, LLC | Assisted Living Facility | 605 Carpenters Way, Lakeland, FL 33809-3919 | 2017-09-22 |
| 1972975605 | The Manor At Lake Morton | Assisted Living Facility | 522 E Lime St, Lakeland, FL 33801-5313 | 2015-10-21 |
| 1750700860 | Grace Manor Suites | Assisted Living Facility | 4620 N Socrum Loop Road, Lakeland, FL 33809 | 2014-04-16 |
| 1780019992 | Florida Living Options Inc | Assisted Living Facility | 6150 Lakeland Highlands Rd, Lakeland, FL 33813-3850 | 2013-09-06 |
| 1922396431 | Kindhearted Assisted Living Facility, Inc. | Assisted Living Facility | 2815 Cleveland Heights Blvd, Lakeland, FL 33803-4107 | 2011-07-18 |
| 1477858520 | Lwrc Inc | Assisted Living Facility | 315 W Peachtree St, Lakeland, FL 33815-1531 | 2011-01-21 |
| 1013167691 | Lake Morton Plaza, LLC | Assisted Living Facility | 400 S Florida Ave, Lakeland, FL 33801-5254 | 2008-09-19 |
| 1740449263 | Andrada Guerzon #1 Corp | Assisted Living Facility | 815 W Daughtery Rd, Lakeland, FL 33809-3121 | 2008-06-09 |
| 1992979405 | Sedona Garden Assisted Living & Memory Care | Assisted Living Facility | 610 E Lime St, Lakeland, FL 33801-5444 | 2008-04-15 |
| Find all providers in LAKELAND | ||||
Please comment or provide details below to improve the information on SUMMERVILLE AT LAKELAND, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.