Healthcare Provider Details

I. General information

NPI: 1679347108
Provider Name (Legal Business Name): BIG MOMMY HOME OF LOVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 N LUDLOW ST STE 212
DAYTON OH
45402-1165
US

IV. Provider business mailing address

919 S BROADWAY ST
DAYTON OH
45417-3914
US

V. Phone/Fax

Practice location:
  • Phone: 937-608-8470
  • Fax:
Mailing address:
  • Phone: 937-608-8470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DEANNE GROVES
Title or Position: PROVIDER
Credential: INDEPENDENT PROVIDER
Phone: 937-608-8470