MEDICARE: JMB LOVING CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1962115428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JMB LOVING CARE LLC

Provider Business Mailing Address
First Line	:	5049 SOUTHSHORE DR
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-3063
Country	:	US
Telephone Number	:	201-921-4846
Fax Number	:

Provider Business Practice Location Address
First Line	:	1629 GULF RD
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-2718
Country	:	US
Telephone Number	:	201-921-4846
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHELLE A BRADLEY
Credential	:
Telephone Number	:	201-921-4846

Provider Enumeration Date	:	12/29/2022
Last Update Date	:	12/29/2022

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