Provider Demographics
NPI:1861896284
Name:STEPHANIE'S LOVE & CARE (ALF)
Entity type:Organization
Organization Name:STEPHANIE'S LOVE & CARE (ALF)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BELLAMY
Authorized Official - Suffix:
Authorized Official - Credentials:ASSISTED LIVING
Authorized Official - Phone:904-388-7086
Mailing Address - Street 1:3056 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-2539
Mailing Address - Country:US
Mailing Address - Phone:904-388-7086
Mailing Address - Fax:
Practice Address - Street 1:3056 W 1ST ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-2539
Practice Address - Country:US
Practice Address - Phone:904-388-7086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL107933104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1801198460OtherNPI
FL142571400Medicaid