GRACE MANOR AT LAKE MORTON (NPI# 1336587708) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336587708 |
| Entity Type | Organization |
| Organization Name | GRACE MANOR AT LAKE MORTON |
| Practice Address |
610 E Lime Street Lakeland FL 33801 |
| Mailing Address |
Po Box 2480 Lakeland FL 33806-2480 |
| Practice Telephone | 8639379114 |
| Practice Fax Number | 8639379117 |
| Mailing Telephone | 8639379114 |
| Mailing Fax Number | 8635105952 |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2014-11-20 |
| Authorized Official Name | MS. JENNIFER LYNN GARRARD (ASST. ADMINISTRATOR) |
| Authorized Official Telephone | 8632260358 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311500000X | Alzheimer Center (Dementia Center) | Nursing & Custodial Care Facilities |
| Street Address |
610 E LIME STREET |
| City | LAKELAND |
| State | FL |
| Zip Code | 33801 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508473802 | Camryn Nichole White | Assistant Behavior Analyst | 301 South Florida Ave, Lakeland, FL 33801 | 2020-09-30 |
| 1932719242 | Jimia Watkins | Home Health Aide | 2410 Lakeview St, Lakeland, FL 33801 | 2020-08-03 |
| 1396366886 | Erin Zimmer | Health Educator | 491 Lake Parker Ave, Lakeland, FL 33801 | 2020-05-06 |
| 1013473206 | Madelyn Claire Burley | Occupational Therapist | 1215 East Orange Street, Lakeland, FL 33801 | 2019-02-13 |
| 1992260319 | Publix Super Markets, Inc. | Durable Medical Equipment & Medical Supplies | 1617 Us Highway 98 S, Lakeland, FL 33801 | 2019-02-11 |
| 1669908836 | Integrative Physical Medicine of Lakeland LLC | Specialist | 1205 East Magnolia St, Suite 105, Lakeland, FL 33801 | 2017-05-10 |
| 1689111502 | Daryl Dowding | Counselor | 390 Alcaia Rd., Lakeland, FL 33801 | 2017-01-30 |
| 1023481926 | Joseph D'alessandro | Specialist/Technologist | 111 Lake Hollingsworth Dr Box 4334, Lakeland, FL 33801 | 2015-11-02 |
| 1588030894 | Donna Lee Buckner | Specialist/Technologist | 111 Mosswood Road, Lakeland, FL 33801 | 2015-08-20 |
| 1144635780 | Donna Paige Mccraney | Nurse Practitioner | 111 Lake Hollingsworth Drive, Florida Southern College Student Health Center, Lakeland, FL 33801 | 2014-06-23 |
| Find all providers in zip 33801 | ||||
| Taxonomy Code | 311500000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Alzheimer Center (Dementia Center) |
| A freestanding facility or special care unit of a long term care facility focusing on patient care of individuals diagnosed with dementia or Alzheimer’s Disease or their related diseases. Six elements of the facility/unit set it apart from other (the rest of the) facilities(y): Admission of residents with dementia (including those with Alzheimer's disease); Staff who are specially selected, trained, and supervised; Activities that are specifically designed for the cognitively impaired; A marketing of a special care unit in brochures; A high level of family involvement; and A physical environment designed to keep residents safe and segregated from other populations. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437319514 | Polk County Board of County Commissioners | Alzheimer Center (Dementia Center) | 1200 Southern Ave, Lakeland, FL 33815-3976 | 2008-06-12 |
| 1518176346 | Summerville At Lakeland, LLC | Alzheimer Center (Dementia Center) | 2111 Lakeland Hills Blvd., Brookdale Lakeland Hills, Lakeland, FL 33803 | 2007-05-21 |
| 1861639585 | Esc New Port Richey, LLC | Alzheimer Center (Dementia Center) | 3110 Oakbridge Blvd E, Lakeland, FL 33803-5987 | 2009-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114527744 | Somh Boca Raton Operating, LLC | Alzheimer Center (Dementia Center) | 21865 Ponderosa Dr, Boca Raton, FL 33428-6215 | 2020-11-01 |
| 1417556978 | Mh Gentry Park Al Operating, LLC | Alzheimer Center (Dementia Center) | 3201 Center Pointe Dr, Orlando, FL 32825-6323 | 2020-10-25 |
| 1144876327 | Immaculate Adult Day Care LLC | Alzheimer Center (Dementia Center) | 234 Willard St Ste A, Cocoa, FL 32922-7984 | 2019-08-14 |
| 1982172995 | Pacifica Augustine Road LLC | Alzheimer Center (Dementia Center) | 10660 Old Augustine Road, Jacksonville, FL 32257 | 2018-11-07 |
| 1689152910 | American Eagle Leesburg Mc LLC | Alzheimer Center (Dementia Center) | 710 S Lake St, Leesburg, FL 34748-7327 | 2018-07-30 |
| 1518445857 | American Eagle Venice Island LLC | Alzheimer Center (Dementia Center) | 1200 Avenida Del Circo, Venice, FL 34285 | 2018-07-30 |
| 1780160192 | Ganesh Healthcare of Jax LLC | Alzheimer Center (Dementia Center) | 644 Cesery Blvd Ste 150, Jacksonville, FL 32211 | 2018-07-18 |
| 1861917171 | Memory Lane Cottage At Oviedo, LLC | Alzheimer Center (Dementia Center) | 450 Oviedo Blvd, Oviedo, FL 32765-3508 | 2017-08-08 |
| 1891219119 | Waveney Gittens-williams | Alzheimer Center (Dementia Center) | 3706 W. Idle Wild Cir #203, Tampa, FL 33614 | 2017-07-28 |
| 1831640697 | Senior Living Iv Sun City, LLC | Alzheimer Center (Dementia Center) | 1320 33rd St Se, Ruskin, FL 33573-4904 | 2016-10-17 |
| Find all providers with the same taxonomy | ||||
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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.