MEDICARE: PREVENTIVE HEALTHCARE SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency	L14000072148	FL

General Provider Information

NPI Number	:	1083025563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREVENTIVE HEALTHCARE SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	1782 SAINT CROIX DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-2013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1782 SAINT CROIX DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-2013
Country	:	US
Telephone Number	:	727-348-5702
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	VONDA LOVE
Credential	:
Telephone Number	:	727-348-5702

Provider Enumeration Date	:	05/19/2014
Last Update Date	:	03/02/2015

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