MEDICARE: LOVING LIFE ENTERPRISES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	251B00000X	Case Management Agency	FL
2	251C00000X	Developmentally Disabled Services Day Training Agency	FL
3	251E00000X	Home Health Agency
4	251S00000X	Community/Behavioral Health Agency
5	347C00000X	Private Vehicle	FL
6	253Z00000X	In Home Supportive Care Agency	FL

General Provider Information

NPI Number	:	1356669758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING LIFE ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	3034 S 78TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-6506
Country	:	US
Telephone Number	:	813-410-2399
Fax Number	:	813-612-9491

Provider Business Practice Location Address
First Line	:	3034 S 78TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-6506
Country	:	US
Telephone Number	:	813-410-2399
Fax Number	:	813-612-9491

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	KAY TARVER
Credential	:
Telephone Number	:	813-410-2399

Provider Enumeration Date	:	05/10/2010
Last Update Date	:	02/16/2011

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