Provider Demographics
NPI:1538523568
Name:LOVELY HEART SERVICE
Entity type:Organization
Organization Name:LOVELY HEART SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWER
Authorized Official - Prefix:MS
Authorized Official - First Name:KEMISHA
Authorized Official - Middle Name:LATOYA
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-851-6261
Mailing Address - Street 1:2437 E 11TH ST
Mailing Address - Street 2:D-102
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-4467
Mailing Address - Country:US
Mailing Address - Phone:850-851-6261
Mailing Address - Fax:
Practice Address - Street 1:2437 E 11TH ST
Practice Address - Street 2:D-102
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-4467
Practice Address - Country:US
Practice Address - Phone:850-851-6261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based