Healthcare Provider Details

I. General information

NPI: 1881093714
Provider Name (Legal Business Name): LOVED ONES HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3431 BRAHMA BULL CIR N
JACKSONVILLE FL
32226-4879
US

IV. Provider business mailing address

3431 BRAHMA BULL CIR N
JACKSONVILLE FL
32226-4879
US

V. Phone/Fax

Practice location:
  • Phone: 904-554-6051
  • Fax: 904-361-3235
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number6906679
License Number StateFL

VIII. Authorized Official

Name: WISLY NOEL
Title or Position: OWNER
Credential:
Phone: 904-554-6051