Healthcare Provider Details

I. General information

NPI: 1568900207
Provider Name (Legal Business Name): LOVETTA ALECIA HOUSTON GNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 01/03/2022
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2413 ARUNAH AVE
BALTIMORE MD
21216-4824
US

IV. Provider business mailing address

2413 ARUNAH AVE
BALTIMORE MD
21216-4824
US

V. Phone/Fax

Practice location:
  • Phone: 410-314-8463
  • Fax:
Mailing address:
  • Phone: 410-314-8463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHCS800393
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: