Basic Information
| Provider Information | |||||||||
| NPI: | 1992059489 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOREAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1694 BAYHILL DR | ||||||||
| Address2: | |||||||||
| City: | OLDSMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346771956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277871260 | ||||||||
| FaxNumber: | 7277875137 | ||||||||
| Practice Location | |||||||||
| Address1: | 747 BON AIR ST | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338054631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636881196 | ||||||||
| FaxNumber: | 8636877707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2012 | ||||||||
| LastUpdateDate: | 11/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | BONA | ||||||||
| AuthorizedOfficialFirstName: | RAFAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MGR | ||||||||
| AuthorizedOfficialTelephone: | 7274392677 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.