Provider Demographics
NPI:1437652039
Name:LOVE AND KINDNESS DISABLE AND ELDERLY COMPANIONSHIP
Entity Type:Organization
Organization Name:LOVE AND KINDNESS DISABLE AND ELDERLY COMPANIONSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANITA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:BOWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-688-5244
Mailing Address - Street 1:2121 HARRISON AVE APT G7
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4564
Mailing Address - Country:US
Mailing Address - Phone:850-688-5244
Mailing Address - Fax:
Practice Address - Street 1:1180 W WASHINGTON ST STE C
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-1127
Practice Address - Country:US
Practice Address - Phone:850-688-5244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-10
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL020363100376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020363100Medicaid