Provider Demographics
NPI:1154604312
Name:LOVING HEART ADULT DAY CARE, INC
Entity type:Organization
Organization Name:LOVING HEART ADULT DAY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:239-437-2788
Mailing Address - Street 1:5711 INDEPENDENCE CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4444
Mailing Address - Country:US
Mailing Address - Phone:239-437-2788
Mailing Address - Fax:239-437-2789
Practice Address - Street 1:5711 INDEPENDENCE CIR STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4444
Practice Address - Country:US
Practice Address - Phone:239-437-2788
Practice Address - Fax:239-437-2789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9183261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care