MEDICARE: 1LIFE1LOVE, INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1952687287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1LIFE1LOVE, INC.

Provider Business Mailing Address
First Line	:	739 THIMBLE SHOALS BLVD STE 404
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-3562
Country	:	US
Telephone Number	:	757-310-6141
Fax Number	:	757-310-6230

Provider Business Practice Location Address
First Line	:	739 THIMBLE SHOALS BLVD STE 404
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-3562
Country	:	US
Telephone Number	:	757-310-6141
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MRS. SHERRRIE BOONE
Credential	:
Telephone Number	:	757-310-6141

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	11/05/2019

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