Healthcare Provider Details

I. General information

NPI: 1689496291
Provider Name (Legal Business Name): LAVISH CARE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7326 MANGUM DR
PENSACOLA FL
32504-6477
US

IV. Provider business mailing address

7326 MANGUM DR
PENSACOLA FL
32504-6477
US

V. Phone/Fax

Practice location:
  • Phone: 833-340-9201
  • Fax:
Mailing address:
  • Phone: 833-340-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State

VIII. Authorized Official

Name: LISA CAMPBELL
Title or Position: OWNER: LPN
Credential: LPN
Phone: 850-382-5033