Healthcare Provider Details

I. General information

NPI: 1982241477
Provider Name (Legal Business Name): LOVING STEPS FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 TWAIN LN
NORTH CHESTERFIELD VA
23224-4421
US

IV. Provider business mailing address

2811 TWAIN LN
NORTH CHESTERFIELD VA
23224-4421
US

V. Phone/Fax

Practice location:
  • Phone: 804-316-6234
  • Fax:
Mailing address:
  • Phone: 804-316-6234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KELVIN LORENZO MCDANIEL SR.
Title or Position: CEO
Credential:
Phone: 804-316-6234