Healthcare Provider Details

I. General information

NPI: 1912446352
Provider Name (Legal Business Name): LOVING HEART ADULT DAY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 NE 2ND PL SUITE 100
CAPE CORAL FL
33909-1955
US

IV. Provider business mailing address

422 NE 2ND PL SUITE 100
CAPE CORAL FL
33909-1955
US

V. Phone/Fax

Practice location:
  • Phone: 239-443-5337
  • Fax:
Mailing address:
  • Phone: 239-443-5337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9380
License Number StateFL

VIII. Authorized Official

Name: MIGUEL DIAZ
Title or Position: CEO
Credential:
Phone: 239-443-5337