Provider Demographics
NPI:1063263861
Name:LAKE WORTH REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:LAKE WORTH REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-215-8610
Mailing Address - Street 1:101 SUNNYTOWN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3862
Mailing Address - Country:US
Mailing Address - Phone:407-215-8610
Mailing Address - Fax:
Practice Address - Street 1:1201 12TH AVE S
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-5409
Practice Address - Country:US
Practice Address - Phone:561-586-7404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOVEREIGN HEALTHCARE HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility