MEDICARE: NURTURE CARE LOVE, 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	261QD1600X	Developmental Disabilities Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922581586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURTURE CARE LOVE, INC.

Provider Business Mailing Address
First Line	:	2313 3RD ST SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-3357
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2313 3RD ST SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-3357
Country	:	US
Telephone Number	:	754-214-9628
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVIDSON ANTOINE
Credential	:
Telephone Number	:	754-214-9628

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	09/11/2018

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