Healthcare Provider Details

I. General information

NPI: 1679012165
Provider Name (Legal Business Name): LIBERATING LOVE CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 PETERS RD SUITE 1000-82
PLANTATION FL
33324-3265
US

IV. Provider business mailing address

8201 PETERS RD SUITE 1000-82
PLANTATION FL
33324-3265
US

V. Phone/Fax

Practice location:
  • Phone: 888-608-1950
  • Fax: 754-800-3902
Mailing address:
  • Phone: 888-608-1950
  • Fax: 754-800-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. GRACE LOVE
Title or Position: PRESIDENT/ ADMINISTRATOR
Credential:
Phone: 888-608-1950