- Enrollment id
- O20161104000018
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1184082828
- Multiple npi flag
- N
- Ccn
- 105892
- Associate id
- 6204114796
- Organization name
- LAKE PARK OPERATIONS, LLC
- Doing business as name
- LAKE PARK OF MADISON NURSING AND REHABILITATION CENTER
- Incorporation date
- 2016-02-08
- Incorporation state
- FL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- LAKE PARK OF MADISON NURSING AND REHABILITATION CE
- Affiliation entity name
- MAXIMUS HEALTHCARE GROUP
- Affiliation entity id
- 338
- Address line 1
- 259 SW CAPTAIN BROWN RD
- City
- MADISON
- State
- FL
- Zip code
- 323404316