Healthcare Provider Details

I. General information

NPI: 1487137030
Provider Name (Legal Business Name): K AND L LOVING CARE OF LEHIGH ACRES ASSISTED LIVING FACILITY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4504 6TH ST W
LEHIGH ACRES FL
33971-1100
US

IV. Provider business mailing address

3825 ASPEN LEAF DR
BOYNTON BEACH FL
33436-1713
US

V. Phone/Fax

Practice location:
  • Phone: 561-628-8075
  • Fax:
Mailing address:
  • Phone: 561-628-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number StateNULL

VIII. Authorized Official

Name: LOTOYA HIBBERT
Title or Position: ADMINISTRATOR
Credential:
Phone: 561-628-8075