Provider Demographics
NPI:1033528716
Name:LOVE SENIORS HOME INC
Entity Type:Organization
Organization Name:LOVE SENIORS HOME INC
Other - Org Name:LOVE SENIORS HOME INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANTINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-304-9590
Mailing Address - Street 1:450 SAIL LN
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4809
Mailing Address - Country:US
Mailing Address - Phone:321-304-9590
Mailing Address - Fax:321-338-2910
Practice Address - Street 1:460 SAIL LANE
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953
Practice Address - Country:US
Practice Address - Phone:321-304-9590
Practice Address - Fax:321-338-2910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOVE SENIORS HOME INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities