CCRC - LAKE PORT SQUARE, LLC
NPI 1073927331
Skilled Nursing Facility in Leesburg, FL
Overall Rating: 1 out of 5 stars
NPI Status: Active since June 16, 2014
Contact Information
701 LAKE PORT BLVD
LEESBURG, FL
ZIP 34748
Phone: (352) 728-3366
- Organization
- Skilled Nursing Facility
- Accepts Insurance
- CLIA Number: 10D0874007
- CLIA Cert. Type: Skilled Nursing Facility/Nursing Facility
- CLIA Exp. Date: 08-03-2027
About CCRC - LAKE PORT SQUARE, LLC
This page provides the complete NPI Profile along with additional information for Ccrc - Lake Port Square, Llc, a provider established in Leesburg, Florida operating as a Skilled Nursing Facility. The healthcare provider is registered in the NPI registry with number 1073927331 assigned on June 2014. The practitioner's primary taxonomy code is 314000000X. The provider is registered as an organization and their NPI record was last updated January 2026. The provider's
- NPI
- 1073927331
- Provider Legal Name
- CCRC - LAKE PORT SQUARE, LLC
- Other Organization Name
- Other Name Type
- (6)
- Entity Type
- Organization
- Location Address
- 701 LAKE PORT BLVD LEESBURG, FL 34748
- Location Phone
- (352) 728-3366
- Mailing Address
- 1920 MAIN ST STE 1200 IRVINE, CA 92614
- Mailing Phone
- (949) 407-0700
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 06-16-2014
- Last Update Date
- 01-19-2026
- Code Navigator
According to the Nursing Home Compare program data, Ccrc - Lake Port Square, Llc has a much below average overall quality rating based on the provider's performance on three separate measures including: health inspections, staffing, and quality of resident care information. These quality measures, combined in a star rating of 1 out of 5 stars provide a snapshot of this nursing home quality.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Skilled Nursing Facility
- Taxonomy Code
- 314000000X
- Type
- Nursing & Custodial Care Facilities
- Taxonomy Description
- (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Complete VALUE Gold - HMO
- Focused VALUE Silver - HMO
- Focused VALUE Silver + Vision + Adult Dental - HMO
- Standard Gold VALUE - HMO
- Standard Silver VALUE - HMO
- Standard Silver VALUE + Vision + Adult Dental - HMO
- Clarity Silver - HMO
- Clarity VALUE Silver - HMO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Complete VALUE Gold - HMO
- Elite Bronze - HMO
- Elite Bronze + Vision + Adult Dental - HMO
- Elite VALUE Bronze - HMO
- Enhanced Diabetes Care Silver with $0 Drug Options - HMO
- Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - HMO
- Complete Gold - EPO
- Complete Gold + Vision + Adult Dental - EPO
- Elite Bronze - EPO
- Elite Bronze + Vision + Adult Dental - EPO
- Elite Gold - EPO
- Elite Gold + Vision + Adult Dental - EPO
- Enhanced Diabetes Care Silver with $0 Drug Options - EPO
- Enhanced Diabetes Care Silver with $0 Drug Options + Vision + Adult Dental - EPO
- Everyday Bronze - EPO
- Everyday Bronze + Vision + Adult Dental - EPO
- AvMed Entrust Bronze 600 (2026) - HMO
- AvMed Entrust Bronze 650 (2026) - HMO
- AvMed Entrust Expanded Bronze Standard (2026) - HMO
- AvMed Entrust Gold 125 (2026) - HMO
- AvMed Entrust Gold 125 Dental+Vision (2026) - HMO
- AvMed Entrust Gold Standard (2026) - HMO
- AvMed Entrust Platinum 25 (2026) - HMO
- AvMed Entrust Platinum 25 Dental+Vision (2026) - HMO
- AvMed Entrust Platinum Standard (2026) - HMO
- AvMed Entrust Silver 350 (2026) - HMO
- BlueOptions Bronze (HSA) 24J01-10 (Rewards / $4 Condition Care Rx) - PPO
- BlueOptions Bronze 24J01-04 (3 PCP Visits for $0 then $55 / $70 Specialist Visits / Rewards) - PPO
- BlueOptions Bronze 24J01-06 (Rewards) - PPO
- BlueOptions Bronze 24J01-17 ($50 PCP Visits / Rewards) - PPO
- BlueOptions Bronze 24J01-18S ($50 PCP Visits / Rewards) - PPO
- BlueOptions Gold 24J01-09 ($0 Deductible / $15 PCP Visits / $75 Specialist Visits / $20 Labs / Rewards) - PPO
- BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards) - PPO
- BlueOptions Gold 24J01-20S ($30 PCP Visits / $60 Specialist Visits / Rewards) - PPO
- BlueOptions Platinum 24J01-05 ($0 Labs / $15 PCP Visits / $35 Specialist Visits / Rewards) - PPO
- BlueOptions Platinum 24J01-08 ($0 Deductible / $0 Labs / $15 PCP Visits / $25 Specialist Visits / Rewards) - PPO
- UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care) - HMO
- UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision) - HMO
- UHC Bronze Essential ($0 Virtual Urgent Care) - HMO
- UHC Bronze Essential- ($0 Virtual Urgent Care) - HMO
- UHC Bronze Standard - HMO
- UHC Bronze Standard+ (Dental + Vision) - HMO
- UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx) - HMO
- UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision) - HMO
- UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx) - HMO
- UHC Gold Standard - HMO
- Wellpoint Essential Bronze 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Bronze 5500 Adult Dental/Vision ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Bronze 6000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Bronze 7500 ($0 Virtual PCP + $0 Select Drugs + Incentives) Standard - HMO
- Wellpoint Essential Catastrophic (+ Incentives) - HMO
- Wellpoint Essential Gold 1400 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Gold 2000 ($0 Virtual PCP + $0 Select Drugs + Incentives) Standard - HMO
- Wellpoint Essential Gold 800 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Gold 800 Adult Dental/Vision ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
- Wellpoint Essential Silver 1850 ($0 Virtual PCP + $0 Select Drugs + Incentives) - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Nursing Home Quality Information
The Centers for Medicare and Medicaid Services publishes the Nursing Home Compare star rating data to provide consumers an easy way to compare nursing home's quality of care.
| Overall Quality Rating | - 1 out of 5 stars - Much Below Average |
| The overall star rating is based on a nursing homes's performance on health inspections, staffing and quality measures. | |
| Health Inspection Rating | Not Available |
| The health inspection star rating is based on a nursing home’s weighted score from the most recent health inspections. | |
| Quality Measures Rating | - 3 out of 5 stars - Average |
| The quality measures star rating is based on data from a select set of clinical measures. | |
| Long-Stay Quality Measures Rating | - 3 out of 5 stars - Average |
| The long-stay quality of care rating is based on the quality of care delivered to long-term residents only. | |
| Short-Stay Quality Measures Rating | - 4 out of 5 stars - Above Average |
| The short-stay quality of care rating is based on the quality of care delivered to temporary residents only. | |
| Staffing Rating | - 3 out of 5 stars - Average |
| The staffing rating is based on the star rating based on the nursing home’s staffing hours for Registered Nurses (RNs), Licensed Practice Nurses (LPNs), Licensed Vocational Nurses (LVNs) and Nurse aides. | |
| Nurse Aide Staffing Hours | 2.33 hours per resident per day |
| Nurse aide hours per resident per day. Higher number of hours are better. | |
| RN Staffing Hours | 0.71 hours per resident per day |
| Resgistered nurse hours per resident per day. Higher number of hours are better. | |
| RN Staff Turnover | 71.4% |
| Resgistered nurse turnover is the percentage of registered nursing staff who stop working at the facility within a given year. | |
| Ownership Type | For profit - Limited Liability company |
| Is the facility private for profit, not-for profit or publicly owned. | |
| Number of Certified Beds | 80 beds |
| Number of beds in the nursing home that have been approved by the federal government to participate in the Medicare or Medicaid programs. | |
| Residents per Day | 63 residents |
| Average number of residents living in the facility per day. | |
| Automatic Sprinkler Systems | Yes |
| Does the facility have automatic sprinkler systems in all required areas? | |
| Facility Reported Incidents | 0 incidents |
| Number of facility-reported incidents in the past 3 years. A lower number is better. | |
| Substantiated Complaints | 0 complaints |
| Number of substantiated complaints in the past 3 years. A lower number is better. | |
| Citations from Inspections | 0 citations after infection control inspection |
| Number of citations from infection control inspections in the past 3 years. A lower number is better. | |
| Total Number of Penalties | 4 penalties from a serious health, fire safety or long-term unresolved citation |
| The Medicare program may impose penalties on a facilty when there's serious health or fire safety citations or if the facility fails to correct a citation for a long period of time. | |
| Number of Fines | 4 fines |
| Toal number of fines in the last 3 years. A penalty can be a fine against the facility or denied payments from Medicare. | |
| Amount of Fines | $228465.00 |
| Total monetary amount of fine imposed on the facility in the last 3 years. | |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 10D0874007
- Facility Type
- Skilled Nursing Facility/Nursing Facility
- Certificate Effective Date
- August 04, 2025
- Certificate Expiration Date
- August 03, 2027
- Laboratory Director
- CHARLENE WEBSTER
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Ccrc - Lake Port Square, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1073927331, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 59. The final step is to find the difference between that total and the next multiple of ten (60 - 59 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 59 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 6 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1073927331, enumerated as an "organization" on June 16, 2014.
The provider is located at 701 LAKE PORT BLVD LEESBURG, FL 34748 and the phone number is (352) 728-3366.
Skilled Nursing Facility with taxonomy code 314000000X.
The provider might be accepting Accepts: Ambetter from Superior HealthPlan, Ambetter. Please consult your insurance carrier or call the provider to verify.
