MEDICARE: LOVING SOULS CARE SERVICES INC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1124736798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING SOULS CARE SERVICES INC

Provider Business Mailing Address
First Line	:	10300 SW 72ND ST STE 261D
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10300 SW 72ND ST STE 261D
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3014
Country	:	US
Telephone Number	:	786-344-4173
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARIA K FRAGA MEDEROS
Credential	:
Telephone Number	:	786-344-4173

Provider Enumeration Date	:	11/11/2022
Last Update Date	:	11/11/2022

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