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General NPI Number Information
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NPI Number | 1346828787
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Entity Type | Organization
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Legal Business Name | JACOBS TENDER LOVING CARE ASSISTED LIVING FACILITY
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 7000 NW 6TH ST # 33317
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City | PLANTATION
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State | FL
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Zip | 33317-1102
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Country | US
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Telephone | 954-512-8450
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Fax |
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Provider Business Mailing Address
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Address Line | 7000 NW 6TH ST # 33317
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City | PLANTATION
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State | FL
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Zip | 33317-1102
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Country | US
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Telephone | 954-512-8450
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MS. LAREMISE MONESTIME
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Credential | RN
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Telephone | 754-223-4165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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