Provider Demographics
NPI:1427417419
Name:LOVELY HEART SERVICE
Entity Type:Organization
Organization Name:LOVELY HEART SERVICE
Other - Org Name:KEMISHA MATHIS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:
Authorized Official - First Name:KEMISHA
Authorized Official - Middle Name:LATOYA
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:DOA
Authorized Official - Phone:850-851-6261
Mailing Address - Street 1:2805 EVELYN AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5861
Mailing Address - Country:US
Mailing Address - Phone:850-851-6261
Mailing Address - Fax:
Practice Address - Street 1:2805 EVELYN AVE APT 3A
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5861
Practice Address - Country:US
Practice Address - Phone:850-851-6261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health