Provider Demographics
NPI:1568940559
Name:M&M LOVING CARE SERVICES LLC
Entity Type:Organization
Organization Name:M&M LOVING CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYOLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCEBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-601-1652
Mailing Address - Street 1:2905 JEFFERSON ST W
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-2180
Mailing Address - Country:US
Mailing Address - Phone:352-601-1652
Mailing Address - Fax:
Practice Address - Street 1:2905 JEFFERSON ST W
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-2180
Practice Address - Country:US
Practice Address - Phone:352-601-1652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL713913Medicaid