Provider Demographics
NPI:1215543657
Name:LOVELY HOME ALF, LLC
Entity Type:Organization
Organization Name:LOVELY HOME ALF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TENESCA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-543-4189
Mailing Address - Street 1:1246 HARLINGEN RD SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-7146
Mailing Address - Country:US
Mailing Address - Phone:321-543-4189
Mailing Address - Fax:321-327-3698
Practice Address - Street 1:1246 HARLINGEN RD SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-7146
Practice Address - Country:US
Practice Address - Phone:321-543-4189
Practice Address - Fax:321-327-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances