=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619390770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LONNOLLIES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2014
-----------------------------------------------------
Last Update Date | 01/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4495 S COUNTY ROAD 229
-----------------------------------------------------
City | GLEN ST MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32040-5535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-275-4258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4495 S COUNTY ROAD 229
-----------------------------------------------------
City | GLEN ST MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32040-5535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-275-4258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE ASSISTANT
-----------------------------------------------------
Name | PRISCILLA 10 AKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-275-4258
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 372500000X
-----------------------------------------------------
Taxonomy Name | Chore Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 372600000X
-----------------------------------------------------
Taxonomy Name | Adult Companion
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------