- Enrollment id
- O20221229000261
- Enrollment state
- FL
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1710613500
- Multiple npi flag
- N
- Ccn
- 105262
- Associate id
- 3274903653
- Organization name
- BLUE LAKE POST ACUTE LLC
- Doing business as name
- BLUE LAKE POST ACUTE
- Incorporation date
- 2022-08-22
- Incorporation state
- FL
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- BLUE LAKE POST ACUTE
- Affiliation entity name
- ELEVATION HEALTHCARE
- Affiliation entity id
- 686
- Address line 1
- 991 E NEW YORK AVE
- City
- DELAND
- State
- FL
- Zip code
- 327245664