Provider Demographics
NPI:1235542572
Name:LOVING EXTENDED FAMILY HOME LLC
Entity Type:Organization
Organization Name:LOVING EXTENDED FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLAUME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-900-4817
Mailing Address - Street 1:5112 N LAUREL CIR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-3100
Mailing Address - Country:US
Mailing Address - Phone:954-900-4817
Mailing Address - Fax:954-900-4817
Practice Address - Street 1:5112 N LAUREL CIR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-3100
Practice Address - Country:US
Practice Address - Phone:954-900-4817
Practice Address - Fax:954-900-4817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility