1245126499 NPI number — JCK LOVE HOME CARE LLC

Table of content: DR. DAVID RUFUS FLOYD OD (NPI 1457421240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245126499 NPI number — JCK LOVE HOME CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JCK LOVE HOME CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245126499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3332 CADENCE LN APT 2221
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76262-2407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-217-7115
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3332 CADENCE LN
Provider Second Line Business Practice Location Address:
APT 2221
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76262-2407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-217-7115
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KUDERHA
Authorized Official First Name:
MAOMBI
Authorized Official Middle Name:
JOSELYNE
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
682-217-7115

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)