Provider Demographics
NPI:1992059489
Name:LOREAL LLC
Entity type:Organization
Organization Name:LOREAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-439-2677
Mailing Address - Street 1:1694 BAYHILL DR
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-1956
Mailing Address - Country:US
Mailing Address - Phone:727-787-1260
Mailing Address - Fax:727-787-5137
Practice Address - Street 1:747 BON AIR ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4631
Practice Address - Country:US
Practice Address - Phone:863-688-1196
Practice Address - Fax:863-687-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility