Healthcare Provider Details

I. General information

NPI: 1780381723
Provider Name (Legal Business Name): COMMUNITY LOVE COMPANIONSHIP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 SW 70TH AVE
DUNNELLON FL
34432-7468
US

IV. Provider business mailing address

15600 SW 70TH AVE
DUNNELLON FL
34432-7468
US

V. Phone/Fax

Practice location:
  • Phone: 352-875-1790
  • Fax:
Mailing address:
  • Phone: 352-875-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY SHELL
Title or Position: OWNER
Credential:
Phone: 352-875-1790