LAKE CENTER OF H.O.P.E., PA
Medical Practice at Professional Dr, Leesburg, FL

License number
Florida 75000006578
Category
Medical Practice
Type
Specialist
Owner
Name: MRS. LOURDES NICOLAS UNGSON OFFICE MANAGER
Title: SECRETARY TREASURER
Phone: (352) 787-0081
Address
Address
33057 Professional Dr SUITE 102, Leesburg, FL 34788
National Provider ID: 1366647802
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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LAKE CENTER OF H.O.P.E., PA

33057 Professional Dr SUITE 102, Leesburg, FL 34788

Status:
Inactive
Inactive reason:
CANCEL ADM DISS/REV
Registration:
Feb 11, 1998
Inactive since:
Oct 23, 2003
State ID:
P98000014007
Business type:
Florida Profit Corporation
Treasurer, Secretarys:
Nick Mmd Ungson (President), 40816 Fletcher Rd, Umatilla, FL 32784 (Physical),Lourdes N Ungson (Treasurer, Secretary), 40816 Fletcher Rd, Umatilla, FL 32784 (Physical)
Agent:
Lourdes Ungson,33057 Professional Dr SUITE 102, Leesburg, FL 34788 (Physical)
EIN:
59-3500597

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