=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871224766
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOVING CARE PRIVATE HOME SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2022
-----------------------------------------------------
Last Update Date | 06/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 BAYSHORE CT
-----------------------------------------------------
City | PUNTA GORDA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33950-5025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-506-2759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 BAYSHORE CT
-----------------------------------------------------
City | PUNTA GORDA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33950-5025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-506-2759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE ASSISTANT
-----------------------------------------------------
Name | LAURA YARINA TAVAREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-506-2759
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------