MEDICARE: BEST LOVING CARE 1 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1265945240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEST LOVING CARE 1 LLC

Provider Business Mailing Address
First Line	:	448 SE JUSTINE TER
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-3248
Country	:	US
Telephone Number	:	718-510-6865
Fax Number	:

Provider Business Practice Location Address
First Line	:	448 SE JUSTINE TER
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-3248
Country	:	US
Telephone Number	:	718-510-6865
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND ADMINISTRATOR
Name	:	MRS. MARIE M GEFFRARD
Credential	:	NURSE
Telephone Number	:	718-510-6865

Provider Enumeration Date	:	11/13/2017
Last Update Date	:	11/13/2017

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