Basic Information
| Provider Information | |||||||||
| NPI: | 1760939813 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEHIGH ACRES BG OPCO LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LEHIGH ACRES PLACE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 N WABASH AVE | ||||||||
| Address2: | SUITE 3700 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606113586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127257000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1251 BUSINESS WAY | ||||||||
| Address2: | |||||||||
| City: | LEHIGH ACRES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339366046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393682500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2016 | ||||||||
| LastUpdateDate: | 09/27/2016 | ||||||||
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| AuthorizedOfficialLastName: | TARSNEY | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED SIGNATORY | ||||||||
| AuthorizedOfficialTelephone: | 3127257000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.