Healthcare Provider Details

I. General information

NPI: 1699334722
Provider Name (Legal Business Name): LOVING CARE AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 MARTIN LUTHER KING JR BLVD
QUINCY FL
32351-3562
US

IV. Provider business mailing address

1804 MARTIN LUTHER KING JR BLVD
QUINCY FL
32351-3562
US

V. Phone/Fax

Practice location:
  • Phone: 850-509-7381
  • Fax:
Mailing address:
  • Phone: 850-933-4980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PORSCHIA MOTEKA JOHNSON
Title or Position: OWNER
Credential:
Phone: 850-933-4980