Healthcare Provider Details

I. General information

NPI: 1467199323
Provider Name (Legal Business Name): HIS LOVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6630 CROSS VIEW LN
MARSING ID
83639-8102
US

IV. Provider business mailing address

6630 CROSS VIEW LN
MARSING ID
83639-8102
US

V. Phone/Fax

Practice location:
  • Phone: 757-374-2404
  • Fax:
Mailing address:
  • Phone: 757-374-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KALAE MORGAN
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 757-374-2404