Healthcare Provider Details

I. General information

NPI: 1235903196
Provider Name (Legal Business Name): LOVE COMMUNITY ACTION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 UTICA AVE UNIT C
BROOKLYN NY
11203-1974
US

IV. Provider business mailing address

535 UTICA AVE UNIT C
BROOKLYN NY
11203-1974
US

V. Phone/Fax

Practice location:
  • Phone: 347-574-5049
  • Fax:
Mailing address:
  • Phone: 347-574-5049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAVAYNE LAWSON
Title or Position: CHIEF PROGRAM OFFICER
Credential:
Phone: 941-830-3647