Healthcare Provider Details

I. General information

NPI: 1083264741
Provider Name (Legal Business Name): LYFE OF LOVE HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3228 BROOKBRIDGE RD
VIRGINIA BEACH VA
23452-4907
US

IV. Provider business mailing address

1509 LAKE CHRISTOPHER DR
VIRGINIA BEACH VA
23464-7212
US

V. Phone/Fax

Practice location:
  • Phone: 757-971-0610
  • Fax:
Mailing address:
  • Phone: 757-202-2321
  • 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. SHANELL RIDDICK
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-202-2321