Provider Demographics
NPI:1710618350
Name:MILDRED LANE HOME CARE SERVICES LLC.
Entity Type:Organization
Organization Name:MILDRED LANE HOME CARE SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-409-7148
Mailing Address - Street 1:1401 ROBERT KING HIGH DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2643
Mailing Address - Country:US
Mailing Address - Phone:863-409-7148
Mailing Address - Fax:
Practice Address - Street 1:1401 ROBERT KING HIGH DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2643
Practice Address - Country:US
Practice Address - Phone:863-409-7148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care