LAKESIDE TLF LLC NPI 1134722820

NPI Information

NPI: 1134722820
Provider Name: LAKESIDE TLF, LLC
Classification: Rehabilitation Hospital - 283X00000X
Entity Type: Organization
CLIA Number: 10D2213676
Address: 1962 VANDOLAH RD
WAUCHULA, FL
ZIP 33873
Phone: (800) 697-5390

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NPI Details

LAKESIDE TLF, LLC is a rehabilitation hospital in Wauchula, FL. The provider is a hospital or facility that provides health-related, social and/or vocational services to disabled persons to help them attain their maximum functional capacity. LAKESIDE TLF, LLC NPI is 1134722820. The provider is registered as an organization entity type.

The provider's business location address is:

1962 VANDOLAH RD
WAUCHULA, FL
ZIP 33873-726
Phone: (800) 697-5390

The provider's authorized official is Maneesh Bansal .
The authorized official title is Coo and has the following contact phone number (800) 697-5390.

The CLIA number assigned to this NPI record is 10D2213676 - other - transitional living facil with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/17/2020 and was last updated on 11/17/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Primary
1	283X00000X	Rehabilitation Hospital	Yes
2	320600000X	Residential Treatment Facility, Intellectual and/or Developmental Disabilities	No
3	320700000X	Residential Treatment Facility, Physical Disabilities	No
4	322D00000X	Residential Treatment Facility, Emotionally Disturbed Children	No

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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