Ccrc - Lake Port Square, LLC
NPI #1073927331 in Leesburg, Florida
Provider Information
- NPI Number
- 1073927331
- Entity Type
- Organization
- Organization Name
- Ccrc - Lake Port Square, LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Jun 16, 2014
- Last Updated
- Jan 19, 2026
Practice Location
Authorized Official
- Name
- TRISTAN MOHADEO
- Title
- ADMINISTRATOR
- Phone
- (352) 728-8525
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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