=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306093430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AM LOVING CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2008
-----------------------------------------------------
Last Update Date | 08/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 PORTER PL
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-3709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-856-5194
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 113 PORTER PLACE
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-856-5194
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. AMIDE PHILOGENE NECENCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-856-5194
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385HR2060X
-----------------------------------------------------
Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
-----------------------------------------------------
License Number | 090967
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------