Provider Demographics
NPI:1346828787
Name:JACOBS TENDER LOVING CARE ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:JACOBS TENDER LOVING CARE ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAREMISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONESTIME
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:754-223-4165
Mailing Address - Street 1:7000 NW 6TH ST # 33317
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1102
Mailing Address - Country:US
Mailing Address - Phone:954-512-8450
Mailing Address - Fax:
Practice Address - Street 1:7000 NW 6TH ST # 33317
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1102
Practice Address - Country:US
Practice Address - Phone:954-512-8450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility