MEDICARE: ONE LOVE CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1770029910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE LOVE CARE LLC

Provider Business Mailing Address
First Line	:	3450 W CHEYENNE AVE STE 200
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8223
Country	:	US
Telephone Number	:	702-787-2116
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 W CHEYENNE AVE STE 200
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-8223
Country	:	US
Telephone Number	:	702-787-2116
Fax Number	:

Authorized Official
Title or Position	:	CEO & PRESIDENT
Name	:	MS. SHINEKA FOY
Credential	:
Telephone Number	:	702-787-2116

Provider Enumeration Date	:	01/11/2017
Last Update Date	:	01/11/2017

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Directions to “ONE LOVE CARE LLC ” Practice Location

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