Basic Information
| Provider Information | |||||||||
| NPI: | 1750057238 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LCS STERLING AVENTURA TENANT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 LOCUST ST STE 820 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503092334 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2777 NE 1834 ST. | ||||||||
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| City: | AVENTURA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331606009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5158754500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2021 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 5158754500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 106675500 | 05 | FL | MEDICAID |