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General NPI Number Information
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NPI Number | 1063616746
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Entity Type | Organization
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Legal Business Name | MISSION OF LOVE CORP.
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2041 S CRATER RD
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City | PETERSBURG
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State | VA
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Zip | 23805-2703
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Country | US
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Telephone | 804-733-8812
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Fax | 804-733-8737
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Provider Business Mailing Address
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Address Line | 2041 S CRATER RD
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City | PETERSBURG
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State | VA
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Zip | 23805-2703
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Country | US
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Telephone | 804-733-8812
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Fax | 804-733-8737
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Authorized Official
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Title or Position | CEO ADMINISTRATOR
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Name | LILLIAN O WILLIAMS
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Credential | RN
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Telephone | 804-733-8812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HCO-07429
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License Number State | VA
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