ISLAND LAKE CENTER, LLC (NPI# 1245228279) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245228279 |
| Entity Type | Organization |
| Organization Name | ISLAND LAKE CENTER, LLC |
| Other Organization Name | ISLAND LAKE CENTER |
| Practice Address |
155 Landover Pl Longwood FL 32750-4924 |
| Practice Telephone | 4078307744 |
| Practice Fax Number | 4078307926 |
| Mailing Telephone | 4078307744 |
| Mailing Fax Number | 4078307926 |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2013-02-13 |
| Authorized Official Name | MRS. JENNIFER ALISE ZIOLKOWSKI (VP FINANCE) |
| Authorized Official Telephone | 8135586629 |
| Authorized Official Credential | MBA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | SNF13460963 | FL | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | AETNA | 0004438180 | 01 |
| FL | 026065700 | 05 | |
| FL | UNITED AMERICAN | C1055643 | 01 |
| FL | BLUE CROSS BLUE SHIELD | K3S | 01 |
| FL | EVERCARE HH CONNECTION | 71-00367 | 01 |
| Other Name | Type Code |
|---|---|
| Island Lake Center | Doing Business As Name - Organization |
| Street Address |
155 LANDOVER PL |
| City | LONGWOOD |
| State | FL |
| Zip Code | 32750-4924 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942443247 | Holly Beth Kluger | Speech-Language Pathologist | 155 Landover Pl, Longwood, FL 32750-4924 | 2009-04-16 |
| 1184867459 | Al Delos Santos Legaspi | Physical Therapist | 155 Landover Pl, Longwood, FL 32750-4924 | 2009-04-15 |
| 1336267624 | Nicole Kelly | Occupational Therapist | 155 Landover Pl, Longwood, FL 32750-4924 | 2007-03-26 |
| 1629177878 | Deborah L Carter | Psychologist | 155 Landover Pl, Island Lake Center, Longwood, FL 32750-4924 | 2006-09-22 |
| 1447273065 | Robert Gerald Kaplan | Internal Medicine | 155 Landover Pl, Longwood, FL 32750-4924 | 2006-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902420920 | Prn Speech Pathologists | Speech-Language Pathologist | 1704 N. Ronald Reagan Blvd, Longwood, FL 32750 | 2020-06-05 |
| 1831743368 | Shamar Anthony Marston | Nurse Anesthetist, Certified Registered | 555 W Fl - 434, Longwood, FL 32750 | 2019-08-01 |
| 1538639125 | Omega Healthcare Solutions, LLC | Case Management | 160 W. Evergreen Avenue Suite 290, Longwood, FL 32750 | 2018-11-27 |
| 1013416080 | Samantha Jane Roberts | Specialist/Technologist, Other | 163 W Bay Ave, Longwood, FL 32750 | 2018-02-06 |
| 1508375874 | Cassandra Thompson-bailey | Nurse Practitioner | 600 N Us Hwy 17 92, Suite 124, Longwood, FL 32750 | 2017-09-29 |
| 1740799535 | Cornerstone Longwood Leasing, LLC | Assisted Living Facility | 480 E. Church Ave., Longwood, FL 32750 | 2017-09-25 |
| 1659890523 | Melissa Shoshana Vigerito | Marriage & Family Therapist | 978 Douglas Ave. Suite 100, Altamonte Springs, FL 32750 | 2017-09-12 |
| 1619498185 | Calm Relief, LLC | Massage Therapist | 1855 W State Road 434, Ste 253, Longwood, FL 32750 | 2017-07-05 |
| 1497145148 | Caitlin Rhea Hilligas | Counselor | 300 N Ronald Reagan Blvd Ste 302, Longwood, FL 32750 | 2015-02-03 |
| 1316344054 | James David Rawlins Jr. | Dentist | 1250 W.s.r 434 Ste. 1008, Longwood, FL 32750 | 2014-11-24 |
| Find all providers in zip 32750 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326030164 | Delta Health Group Inc | Skilled Nursing Facility | 1520 S Grant St, Longwood, FL 32750-6538 | 2005-08-18 |
| 1518579812 | Longwood Operations LLC | Skilled Nursing Facility | 1520 S Grant St, Longwood, FL 32750-6538 | 2020-08-18 |
| 1043479884 | Mf Longwood LLC | Skilled Nursing Facility | 1520 S Grant St, Longwood, FL 32750-6538 | 2008-06-06 |
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| 1306444708 | Center for Comprehensive Services, Inc. | Skilled Nursing Facility | 2411 Clement Rd, Lutz, FL 33549-5552 | 2020-10-16 |
| 1114530227 | Jupiter Rehab and Health Center LLC | Skilled Nursing Facility | 650 Pioneer Rd # 5, Jupiter, FL 33458-8834 | 2020-08-28 |
| 1821601089 | Wellington Rehab and Health Center, LLC | Skilled Nursing Facility | 10330 Nu Vista Ave, Wellington, FL 33414 | 2020-08-27 |
| 1043822349 | Oaks of Kissimmee Operations LLC | Skilled Nursing Facility | 320 N. Mitchell St, Kissimmee, FL 34741-4447 | 2020-08-18 |
| 1720690027 | Brynwood Operations LLC | Skilled Nursing Facility | 1656 S Jefferson St, Monticello, FL 32344-1652 | 2020-08-18 |
| 1326668120 | Key West Nursing Home Propco LLC | Skilled Nursing Facility | 5860 College Road, Key West, FL 33040 | 2020-04-21 |
| 1740800655 | Javara Troupe | Skilled Nursing Facility | 10043 Victory Gallop Loop, Ruskin, FL 33573-6744 | 2020-04-21 |
| 1578199303 | First Coast Health Ventures, LLC | Skilled Nursing Facility | 15480 Max Leggett Parkway, Jacksonville, FL 32218 | 2020-03-12 |
| 1053944116 | Pruitthealth - Southwood, LLC | Skilled Nursing Facility | 2301 Bluff Oak Way, Tallahassee, FL 32311-6161 | 2020-02-18 |
| 1992336895 | Dolphin Pointe Health Care, LLC | Skilled Nursing Facility | 5355 Dolphin Point Rd., Jacksonville, FL 32211 | 2020-01-29 |
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| 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.