Provider Demographics
NPI:1790320984
Name:K AND L LOVING CARE OF PORT SAINT LUCIE ASSISTED LIVING FACILITY, INC
Entity Type:Organization
Organization Name:K AND L LOVING CARE OF PORT SAINT LUCIE ASSISTED LIVING FACILITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LOTOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIBBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:561-628-8075
Mailing Address - Street 1:3825 ASPEN LEAF DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-1713
Mailing Address - Country:US
Mailing Address - Phone:561-628-8075
Mailing Address - Fax:
Practice Address - Street 1:3871 SW RAMSPECK ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5381
Practice Address - Country:US
Practice Address - Phone:561-628-8075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility