Healthcare Provider Details

I. General information

NPI: 1831980432
Provider Name (Legal Business Name): LOVING LIFE AGAIN FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13751 EDWARDS ST APT 48A
WESTMINSTER CA
92683-2961
US

IV. Provider business mailing address

13751 EDWARDS ST APT 48A
WESTMINSTER CA
92683-2961
US

V. Phone/Fax

Practice location:
  • Phone: 313-722-5602
  • Fax:
Mailing address:
  • Phone: 313-722-5602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TYI'SHAUWN WATKINS
Title or Position: FOUNDER & EXECUTIVE DIRECTOR
Credential:
Phone: 313-722-5602