Ccrc - Lake Port Square, LLC
NPI 1073927331 · Skilled Nursing Facility · Leesburg, FL
Enrolled with Medicare as Part a Provider - Skilled Nursing Facility · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Ccrc - Lake Port Square, LLC is a Skilled Nursing Facility organization in Leesburg, FL (NPI 1073927331).
Provider details
- NPI number
- 1073927331
- Entity type
- Organization
- Primary specialty
- Skilled Nursing FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Tristan Mohadeo, Administrator(352) 728-8525
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
12 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Lake Port Square Health Center
Registry dates
- Enumerated
- 2014-06-16
- Last updated
- 2026-01-19
- Certified
- 2026-01-19
Frequently asked questions
- What is Ccrc - Lake Port Square, LLC's NPI number?
- Ccrc - Lake Port Square, LLC's National Provider Identifier (NPI) is 1073927331, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Ccrc - Lake Port Square, LLC?
- Ccrc - Lake Port Square, LLC is classified in the NPPES registry as Skilled Nursing Facility (Nursing & Custodial Care Facilities).
- Where is Ccrc - Lake Port Square, LLC located?
- Ccrc - Lake Port Square, LLC's practice location on file with NPPES is 701 Lake Port Blvd, Leesburg, FL 34748-7674.
- What is Ccrc - Lake Port Square, LLC's phone number?
- The practice phone number listed in the NPPES registry for Ccrc - Lake Port Square, LLC is (352) 728-3366.
- Does Ccrc - Lake Port Square, LLC accept Medicare?
- Ccrc - Lake Port Square, LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Ccrc - Lake Port Square, LLC?
- The authorized official listed on Ccrc - Lake Port Square, LLC's NPPES record is Tristan Mohadeo, Administrator. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Ccrc - Lake Port Square, LLC's NPI active?
- Yes — Ccrc - Lake Port Square, LLC's NPI (1073927331) is active in the NPPES registry as of the last update on 2026-01-19.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.