Healthcare Provider Details

I. General information

NPI: 1750858148
Provider Name (Legal Business Name): LEAN ON ME COMPANION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10048 SOUTHERN PRIDE PLACE
LAKE WORTH FL
33449
US

IV. Provider business mailing address

10048 SOUTHERN PRIDE PLACE
LAKE WORTH FL
33449
US

V. Phone/Fax

Practice location:
  • Phone: 954-488-4191
  • Fax:
Mailing address:
  • Phone: 954-488-4191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: MERLYN BARRETT
Title or Position: OWNER/MANAGER
Credential:
Phone: 561-685-8775