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Organization summary

• NPI
  1073927331
• Name
  Ccrc - Lake Port Square, LLC
• Account Contact
  Tristan Mohadeo
• Address
  701 LAKE PORT BLVD, LEESBURG, FL, 34748-7674
• Phone
  352-728-3366
• Specialties
  Skilled Nursing Facility
• NPPES Last Updated
  2026-01-19

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