MEDICARE: UNCONDITIONAL LOVING HOME HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	251J00000X	Nursing Care Agency
3	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1780205260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNCONDITIONAL LOVING HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	2226 WATERS TRAIL DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-8800
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3325 WASHBURN AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7024
Country	:	US
Telephone Number	:	980-475-9495
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LATOYA D CROCKETT
Credential	:
Telephone Number	:	980-475-9495

Provider Enumeration Date	:	05/06/2020
Last Update Date	:	06/23/2020

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