Basic Information
| Provider Information | |||||||||
| NPI: | 1811338932 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WG HERITAGE LF, LLC | ||||||||
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| OtherOrganizationName: | ATRIA AT LAKE FOREST | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 E. MARKET STREET | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5027794700 | ||||||||
| FaxNumber: | 5027794749 | ||||||||
| Practice Location | |||||||||
| Address1: | 5433 W STATE ROAD 46 | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327719236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073222207 | ||||||||
| FaxNumber: | 4073023411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2013 | ||||||||
| LastUpdateDate: | 10/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | HUDSON | ||||||||
| AuthorizedOfficialFirstName: | W. | ||||||||
| AuthorizedOfficialMiddleName: | BRYAN | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP, GENERAL COUNSEL AND SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 5027794700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | AL10233 | FL | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.