1902340409 NPI number — ESTELLA LOVING CARE, LLC

Table of content: (NPI 1902340409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902340409 NPI number — ESTELLA LOVING CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESTELLA LOVING 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:
1902340409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
665 OGELTHORPE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33897-6298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
132-191-4902
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 DUNDEE RD STE A&B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNDEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33838-4182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-914-9023
Provider Business Practice Location Address Fax Number:
863-353-6658
Provider Enumeration Date:
12/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ESTELLA
Authorized Official First Name:
GUERDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
321-914-9023

Provider Taxonomy Codes

  • Taxonomy code: 385HR2060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2065X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747A0650X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 111388700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 014633400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109090700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111388700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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