Provider Demographics
NPI:1699334722
Name:LOVING CARE AT HOME LLC
Entity type:Organization
Organization Name:LOVING CARE AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PORSCHIA
Authorized Official - Middle Name:MOTEKA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-933-4980
Mailing Address - Street 1:1804 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-3562
Mailing Address - Country:US
Mailing Address - Phone:850-933-4980
Mailing Address - Fax:
Practice Address - Street 1:1804 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-3562
Practice Address - Country:US
Practice Address - Phone:850-509-7381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL744258Medicaid