CLUB AT LAKE GIBSON LLC
NPI 1407684582
Skilled Nursing Facility in Lakeland, FL

Active since July 22, 2024CLIA 10D2209541 · Waiver
855 CARPENTERS WAY, LAKELAND, FL 33809(863) 213-3335 Get Directions Write a Review

NPPES record last updated: July 22, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Club At Lake Gibson Llc NPPES

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

CLUB AT LAKE GIBSON LLC (NPI 1407684582) is a healthcare organization registered as a skilled nursing facility in Lakeland, Florida and active in the NPI registry since July 2024. The organization holds a CLIA Waiver certificate valid through January 13, 2027 and lists Aharon Katz, Authorized Member, as its authorized official.

NPPES Registry Identity

NPI1407684582
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameCLUB AT LAKE GIBSON LLC
Location Address855 CARPENTERS WAYLakeland, FL 33809-4157
Mailing Address855 Carpenters WayLakeland, FL 33809-4157
Organization SubpartNo
Authorized OfficialAharon KatzAuthorized Member · (917) 757-2121
Enumeration DateJuly 22, 2024
NPPES CertifiedJuly 22, 2024
NPI 1407684582 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition

(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.

855 CARPENTERS WAY, Lakeland, FL 33809

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2209541

Club At Lake Gibson LLC, The Dba The Club At Lake Gibson · Lakeland, FL
Active · expires Jan 13, 2027
CLIA Number10D2209541
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateJanuary 14, 2025
Certificate Expiration DateJanuary 13, 2027
Laboratory DirectorMarrissa Antoszyk
Laboratory Phone(863) 213-3335
Laboratory LocationClub At Lake Gibson LLC, The Dba The Club At Lake Gibson855 Carpenters Way, Lakeland, FL 33809
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

Nurse Practitioner (Family)
855 CARPENTERS WAY
LAKELAND, FL 33809
Physical Medicine & Rehabilitation (Sports Medicine)
855 CARPENTERS WAY
LAKELAND, FL 33809
Skilled Nursing Facility
855 CARPENTERS WAY
LAKELAND, FL 33809

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 Club At Lake Gibson LLC's NPI number?

The NPI number for Club At Lake Gibson LLC is 1407684582. It was assigned to this organization in the NPPES registry on July 22, 2024.

Where is Club At Lake Gibson LLC located?

Club At Lake Gibson LLC is located at 855 Carpenters Way, Lakeland, FL 33809. The listed phone number is (863) 213-3335.

What is Club At Lake Gibson LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Club At Lake Gibson LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2209541) is associated with this NPI, valid through January 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Club At Lake Gibson LLC was last updated on July 22, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.