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General NPI Number Information
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NPI Number | 1457098022
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Entity Type | Organization
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Legal Business Name | SOUTHERN LIVE IN INC
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 619 PRINCETON ST
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City | BRANDON
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State | FL
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Zip | 33511-7129
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Country | US
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Telephone | 813-655-0822
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Fax | 813-681-1482
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Provider Business Mailing Address
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Address Line | PO BOX 3528
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City | APOLLO BEACH
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State | FL
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Zip | 33572-1005
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Country | US
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Telephone | 813-381-2406
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Fax | 813-681-1482
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Authorized Official
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Title or Position | OWNER
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Name | MELONIE LIVE-IN OF BESSETTE
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Credential | PRESIDENT
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Telephone | 813-381-2406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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