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General NPI Number Information
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NPI Number | 1790152866
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Entity Type | Organization
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Legal Business Name | SABRINAS LOVE AND CARE
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 1701 LAKE SHORE BLVD APT 2202
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City | JACKSONVILLE
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State | FL
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Zip | 32210-1669
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Country | US
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Telephone | 904-333-0164
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 LAKE SHORE BLVD APT 2202
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City | JACKSONVILLE
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State | FL
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Zip | 32210-1669
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Country | US
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Telephone | 904-333-0164
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Fax |
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Authorized Official
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Title or Position | CNA/OWNER
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Name | SABRINA MALLORY
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Credential |
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Telephone | 904-333-0164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | CNA232585
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License Number State | FL
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