Healthcare Provider Details

I. General information

NPI: 1225291594
Provider Name (Legal Business Name): LOMONICO MANAGEMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 US HIGHWAY 27 S
SEBRING FL
33870-4941
US

IV. Provider business mailing address

2301 US HWY 27 SOUTH
SEBRING FL
33870-4941
US

V. Phone/Fax

Practice location:
  • Phone: 863-402-0406
  • Fax: 863-402-1453
Mailing address:
  • Phone: 863-402-0406
  • Fax: 863-402-1453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number9069
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number9069
License Number StateFL

VIII. Authorized Official

Name: DEBORAH JOY HEARIN
Title or Position: VP
Credential:
Phone: 863-402-0406