Provider Demographics
NPI:1831492685
Name:LOVING CARE SITTERS, INC.
Entity Type:Organization
Organization Name:LOVING CARE SITTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:SHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-686-6322
Mailing Address - Street 1:3550 EBENEZER CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-2049
Mailing Address - Country:US
Mailing Address - Phone:850-686-6322
Mailing Address - Fax:
Practice Address - Street 1:3550 EBENEZER CHURCH RD
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-2049
Practice Address - Country:US
Practice Address - Phone:850-686-6322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCS227324253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL675619100Medicaid