Provider Demographics
NPI:1619390770
Name:LONNOLLIES, LLC
Entity Type:Organization
Organization Name:LONNOLLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:10
Authorized Official - Last Name:AKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-275-4258
Mailing Address - Street 1:4495 S COUNTY ROAD 229
Mailing Address - Street 2:
Mailing Address - City:GLEN ST MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32040-5535
Mailing Address - Country:US
Mailing Address - Phone:904-275-4258
Mailing Address - Fax:
Practice Address - Street 1:4495 S COUNTY ROAD 229
Practice Address - Street 2:
Practice Address - City:GLEN ST MARY
Practice Address - State:FL
Practice Address - Zip Code:32040-5535
Practice Address - Country:US
Practice Address - Phone:904-275-4258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006121500Medicaid