Organization
ELDERLY TENDER LOVING COMPANIONSHIP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAKESHA DEMETRA HOLLINS (OWNER)
(386) 675-2702
Entity
Organization
Contact information
Practice address
336 GRANDE SUNNINGDALE LOOP, DAYTONA BEACH, FL 32124-3039
(386) 675-2702
Mailing address
336 GRANDE SUNNINGDALE LOOP, DAYTONA BEACH, FL 32124-3039
(386) 675-2702
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109625200
—
FL
Enumeration date
06/25/2021
Last updated
06/25/2021
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