Provider Demographics
NPI:1124458799
Name:EXTENDING LOVABLE LIVING ASSISTANCE, LLC
Entity type:Organization
Organization Name:EXTENDING LOVABLE LIVING ASSISTANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LEVETTE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-245-7096
Mailing Address - Street 1:14514 STORYS FORD RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6400
Mailing Address - Country:US
Mailing Address - Phone:321-245-7096
Mailing Address - Fax:321-245-7091
Practice Address - Street 1:14514 STORYS FORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6400
Practice Address - Country:US
Practice Address - Phone:321-245-7096
Practice Address - Fax:321-245-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12433310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility