Provider Demographics
NPI:1437793015
Name:EAGLES NEST OF LOVE LLC
Entity Type:Organization
Organization Name:EAGLES NEST OF LOVE LLC
Other - Org Name:FOREVER YOUNG COMPANION AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ZARANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-815-4776
Mailing Address - Street 1:3848 SUN CITY CENTER BLVD # 104-49
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6843
Mailing Address - Country:US
Mailing Address - Phone:813-815-4776
Mailing Address - Fax:
Practice Address - Street 1:11545 BALINTORE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-3918
Practice Address - Country:US
Practice Address - Phone:813-815-4776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty