Healthcare Provider Details

I. General information

NPI: 1609154392
Provider Name (Legal Business Name): LOVE ONES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 A ST
PANAMA CITY FL
32404-2003
US

IV. Provider business mailing address

3124 A ST
PANAMA CITY FL
32404-2003
US

V. Phone/Fax

Practice location:
  • Phone: 850-763-1519
  • Fax:
Mailing address:
  • Phone: 850-763-1519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberL11000012762
License Number StateFL

VIII. Authorized Official

Name: MRS. SHENEATHA LUSHANN JOHNSON
Title or Position: OWNER
Credential:
Phone: 850-630-8596