Healthcare Provider Details

I. General information

NPI: 1154604312
Provider Name (Legal Business Name): LOVING HEART ADULT DAY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5711 INDEPENDENCE CIR STE 2
FORT MYERS FL
33912-4444
US

IV. Provider business mailing address

5711 INDEPENDENCE CIR STE 2
FORT MYERS FL
33912-4444
US

V. Phone/Fax

Practice location:
  • Phone: 239-437-2788
  • Fax: 239-437-2789
Mailing address:
  • Phone: 239-437-2788
  • Fax: 239-437-2789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9183
License Number StateFL

VIII. Authorized Official

Name: MR. MIGUEL DIAZ
Title or Position: OPERATOR
Credential: RN
Phone: 239-437-2788