Provider Demographics
NPI:1538311303
Name:PRICILLA'S LOVING CARE CORP
Entity Type:Organization
Organization Name:PRICILLA'S LOVING CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YAMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-370-7251
Mailing Address - Street 1:7273 NW 80TH CT
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-7802
Mailing Address - Country:US
Mailing Address - Phone:772-370-7251
Mailing Address - Fax:772-879-6737
Practice Address - Street 1:213 SW LANGFIELD AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-4926
Practice Address - Country:US
Practice Address - Phone:772-370-7251
Practice Address - Fax:772-879-6737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility