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SHADY LANE RETIREMENT HOME
NPI 1114253754
Assisted Living Facility in Leesburg, FL

Active since November 01, 2009
201 ROSEFIELD AVE, LEESBURG, FL 34748(352) 728-1559(352) 728-1703 Get Directions Write a Review

NPPES record last updated: November 1, 2009. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Shady Lane Retirement Home NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHADY LANE RETIREMENT HOME (NPI 1114253754) is a healthcare organization registered as an assisted living facility in Leesburg, Florida and active in the NPI registry since November 2009. The organization lists Segundo Lizardo, Owner/administrator, as its authorized official.

NPPES Registry Identity

NPI1114253754
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameSHADY LANE RETIREMENT HOME
Location Address201 ROSEFIELD AVELeesburg, FL 34748-5014
Mailing Address201 Rosefield AveLeesburg, FL 34748-5014 · (352) 728-1559
Phone(352) 728-1559
Fax(352) 728-1703
Organization SubpartNo
Authorized OfficialSegundo LizardoOwner/administrator · (352) 728-1559
Enumeration DateNovember 1, 2009
✔ NPI 1114253754 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in FL · AL6001
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
201 ROSEFIELD AVE, Leesburg, FL 34748
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Other Identifiers 1

Medicaid2209282005070FL

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SISTER'S WAY LLC
Foster Care Agency
201 ROSEFIELD AVE
LEESBURG, FL 34748
Lake County (313) 600-6325

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shady Lane Retirement Home's NPI number?

The NPI number for Shady Lane Retirement Home is 1114253754. It was assigned to this organization in the NPPES registry on November 1, 2009.

Where is Shady Lane Retirement Home located?

Shady Lane Retirement Home is located at 201 Rosefield Ave, Leesburg, FL 34748. The listed phone number is (352) 728-1559.

What is Shady Lane Retirement Home's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

When was this NPI record last updated?

The NPPES record for Shady Lane Retirement Home was last updated on November 1, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.