Healthcare Provider Details

I. General information

NPI: 1114500782
Provider Name (Legal Business Name): LOVING CARE LINE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BEVERLY AVE
EAST LANSDOWNE PA
19050-2705
US

IV. Provider business mailing address

3 BEVERLY AVE
EAST LANSDOWNE PA
19050-2705
US

V. Phone/Fax

Practice location:
  • Phone: 267-316-8484
  • Fax:
Mailing address:
  • Phone:
  • 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: MUNAH GARDINER
Title or Position: PRESIDENT
Credential:
Phone: 484-343-5536