=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922753573
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE LOVELY HEARTS HOME CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2022
-----------------------------------------------------
Last Update Date | 02/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14211 SW 28TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-6555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-300-5533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14211 SW 28TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-6555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-300-5533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATIA GARCIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-300-5533
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD1600X
-----------------------------------------------------
Taxonomy Name | Developmental Disabilities Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------