Provider Demographics
NPI:1669130589
Name:PRIME LOVE & CARE ASSISTED LIVING LLC
Entity type:Organization
Organization Name:PRIME LOVE & CARE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-970-5558
Mailing Address - Street 1:326 BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3430
Mailing Address - Country:US
Mailing Address - Phone:407-970-5558
Mailing Address - Fax:
Practice Address - Street 1:117 SWEET BAY AVE
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7935
Practice Address - Country:US
Practice Address - Phone:386-402-4084
Practice Address - Fax:386-402-4082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility