=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871986927
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOVING FAMILY SENIOR LIVING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2015
-----------------------------------------------------
Last Update Date | 03/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 153 NW 26TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33127-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-486-6911
-----------------------------------------------------
Fax | 305-985-6170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 153 NW 26TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33127-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-486-6911
-----------------------------------------------------
Fax | 305-985-6170
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SERGIO AMADOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-486-6911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL10952
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------