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General NPI Number Information
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NPI Number | 1508212010
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Entity Type | Organization
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Legal Business Name | PAT'S LOVING CARE ALF INC.
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 3783 BIRCH MOUNTAIN RD
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City | PORT ORANGE
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State | FL
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Zip | 32129-3770
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Country | US
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Telephone | 386-275-5869
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Fax |
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Provider Business Mailing Address
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Address Line | 3783 BIRCH MOUNTAIN RD
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City | PORT ORANGE
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State | FL
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Zip | 32129-3770
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Country | US
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Telephone | 386-275-5869
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. PATRICIA PEARSON
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Credential |
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Telephone | 386-275-5869
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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 | AL12818
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License Number State | FL
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