=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063856532
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOVELOVINGLOVE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2013
-----------------------------------------------------
Last Update Date | 04/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 704 CEDAR AVE
-----------------------------------------------------
City | YEADON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19050-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-931-0826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 704 CEDAR AVE
-----------------------------------------------------
City | YEADON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19050-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | RASHIDA T ALI-CAMPBELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-931-0826
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133NN1002X
-----------------------------------------------------
Taxonomy Name | Nutrition Education Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------