Organization
LOVELY CARE MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANEE PHOUTHAVONG (OWNER)
(727) 754-5309
Entity
Organization
Contact information
Practice address
2869 SARAH DR, CLEARWATER, FL 33759-2010
(727) 754-5309
Mailing address
2869 SARAH DR, CLEARWATER, FL 33759-2010
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12322
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008879500
—
FL
Enumeration date
12/06/2013
Last updated
12/06/2013
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