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General NPI Number Information
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NPI Number | 1033528716
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Entity Type | Organization
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Legal Business Name | LOVE SENIORS HOME INC
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 460 SAIL LANE
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City | MERRITT ISLAND
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State | FL
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Zip | 32953
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Country | US
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Telephone | 321-304-9590
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Fax | 321-338-2910
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Provider Business Mailing Address
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Address Line | 450 SAIL LN
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-4809
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Country | US
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Telephone | 321-304-9590
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Fax | 321-338-2910
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. ANTINA T REED
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Credential |
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Telephone | 321-304-9590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State | FL
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