Healthcare Provider Details

I. General information

NPI: 1760892111
Provider Name (Legal Business Name): LOVING ARMS OUTREACH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 15TH AVE
POMPANO BEACH FL
33069-2829
US

IV. Provider business mailing address

2637 E ATLANTIC BLVD # 26519
POMPANO BEACH FL
33062-4939
US

V. Phone/Fax

Practice location:
  • Phone: 954-696-4135
  • Fax:
Mailing address:
  • Phone: 954-696-4135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL JEREMIAH JOHNSON
Title or Position: DIRECTOR
Credential:
Phone: 954-696-4135