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General NPI Number Information
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NPI Number | 1669130589
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Entity Type | Organization
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Legal Business Name | PRIME LOVE & CARE ASSISTED LIVING LLC
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 117 SWEET BAY AVE
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32168-7935
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Country | US
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Telephone | 386-402-4084
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Fax | 386-402-4082
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Provider Business Mailing Address
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Address Line | 326 BLUFF LN
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City | APOPKA
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State | FL
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Zip | 32712-3430
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Country | US
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Telephone | 407-970-5558
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SABRINA AMAZAN
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Credential |
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Telephone | 407-970-5558
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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 |
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License Number State |
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