Healthcare Provider Details

I. General information

NPI: 1396106191
Provider Name (Legal Business Name): LOVING AT HOME PROFESSIONAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 GITTINGS STREET STE 170
SUFFOLK VA
23434
US

IV. Provider business mailing address

707 GITTINGS STREET STE 170
SUFFOLK VA
23434
US

V. Phone/Fax

Practice location:
  • Phone: 757-998-0635
  • Fax: 757-923-4438
Mailing address:
  • Phone: 757-998-0635
  • Fax: 757-923-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberT1019
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberT1005
License Number StateVA

VIII. Authorized Official

Name: STEPHANIE ADAMS
Title or Position: MANAGER
Credential:
Phone: 757-998-0635