Healthcare Provider Details

I. General information

NPI: 1659557486
Provider Name (Legal Business Name): SPECIAL LOVIN KARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 CYPRESS BAY LOOP RD
PEMBROKE GA
31321-7152
US

IV. Provider business mailing address

70 CYPRESS BAY LOOP RD
PEMBROKE GA
31321-7152
US

V. Phone/Fax

Practice location:
  • Phone: 912-704-4629
  • Fax:
Mailing address:
  • Phone: 912-704-4629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateGA

VIII. Authorized Official

Name: MICHELLE R HARRIS
Title or Position: DIRECTOR
Credential:
Phone: 912-704-4629