=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225291594
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOMONICO MANAGEMENT CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2008
-----------------------------------------------------
Last Update Date | 07/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 US HIGHWAY 27 S
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33870-4941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-402-0406
-----------------------------------------------------
Fax | 863-402-1453
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2301 US HWY 27 SOUTH
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33870-4941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-402-0406
-----------------------------------------------------
Fax | 863-402-1453
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | DEBORAH JOY HEARIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 863-402-0406
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0625X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Mental Illness)
-----------------------------------------------------
License Number | 9069
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 9069
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------