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General NPI Number Information
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NPI Number | 1437793015
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Entity Type | Organization
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Legal Business Name | EAGLES NEST OF LOVE LLC
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Dates
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Enumeration Date | 11/06/2019
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 11545 BALINTORE DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-3918
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Country | US
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Telephone | 813-815-4776
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Fax |
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Provider Business Mailing Address
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Address Line | 3848 SUN CITY CENTER BLVD # 104-49
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City | SUN CITY CENTER
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State | FL
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Zip | 33573-6843
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Country | US
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Telephone | 813-815-4776
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ZARANDA YOUNG
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Credential |
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Telephone | 813-815-4776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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