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General NPI Number Information
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NPI Number | 1538523568
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Entity Type | Organization
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Legal Business Name | LOVELY HEART SERVICE
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 2437 E 11TH ST D-102
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City | PANAMA CITY
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State | FL
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Zip | 32401-4467
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Country | US
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Telephone | 850-851-6261
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Fax |
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Provider Business Mailing Address
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Address Line | 2437 E 11TH ST D-102
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City | PANAMA CITY
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State | FL
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Zip | 32401-4467
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Country | US
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Telephone | 850-851-6261
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Fax |
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Authorized Official
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Title or Position | OWER
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Name | MS. KEMISHA LATOYA MATHIS
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Credential |
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Telephone | 850-851-6261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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