Provider Demographics
NPI:1730610908
Name:BS - LAKELAND HILLS, INC.
Entity type:Organization
Organization Name:BS - LAKELAND HILLS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-687-0101
Mailing Address - Street 1:4141 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-1978
Mailing Address - Country:US
Mailing Address - Phone:863-687-0101
Mailing Address - Fax:863-687-8302
Practice Address - Street 1:4141 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-1978
Practice Address - Country:US
Practice Address - Phone:863-687-0101
Practice Address - Fax:863-687-8302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BS - LAKELAND HILLS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-21
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11751310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility