Provider Demographics
NPI:1629468657
Name:A LOVING LIFE CARE, LLC
Entity Type:Organization
Organization Name:A LOVING LIFE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZULEMA
Authorized Official - Middle Name:MIRIAM
Authorized Official - Last Name:DAVALOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-900-5971
Mailing Address - Street 1:3500 N STATE ROAD 7
Mailing Address - Street 2:SUITE# 213
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5600
Mailing Address - Country:US
Mailing Address - Phone:954-900-5971
Mailing Address - Fax:954-606-0323
Practice Address - Street 1:1920 NW 111TH TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-2284
Practice Address - Country:US
Practice Address - Phone:954-900-5971
Practice Address - Fax:954-606-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL013703600251E00000X
FL013702800251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013702800OtherDEVELOPMENTAL DISABILITY WAIVER PROGRAM
FL013703600Medicaid