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General NPI Number Information
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NPI Number | 1922836824
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Entity Type | Organization
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Legal Business Name | LOVING CARE ASSISTED LIVING HOME
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Dates
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Enumeration Date | 07/23/2024
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 558 RHEINE RD NW
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City | PALM BAY
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State | FL
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Zip | 32907-1044
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Country | US
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Telephone | 321-345-4811
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Fax | 321-821-0256
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Provider Business Mailing Address
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Address Line | 558 RHEINE RD NW
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City | PALM BAY
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State | FL
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Zip | 32907-1044
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Country | US
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Telephone | 321-345-4811
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Fax | 321-821-0256
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JEANETTE THOMPSON
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Credential | RN
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Telephone | 321-213-5531
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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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