Provider Demographics
NPI:1346608106
Name:LOVE CENTER CHURCH, INC.
Entity type:Organization
Organization Name:LOVE CENTER CHURCH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:RACHELLE
Authorized Official - Last Name:SALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-917-4385
Mailing Address - Street 1:955 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-7147
Mailing Address - Country:US
Mailing Address - Phone:321-362-5700
Mailing Address - Fax:321-268-1213
Practice Address - Street 1:955 GRANT RD
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-7147
Practice Address - Country:US
Practice Address - Phone:321-362-5700
Practice Address - Fax:321-268-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12785310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility