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General NPI Number Information
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NPI Number | 1083264741
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Entity Type | Organization
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Legal Business Name | LYFE OF LOVE HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 09/16/2019
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 3228 BROOKBRIDGE RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4907
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Country | US
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Telephone | 757-971-0610
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 LAKE CHRISTOPHER DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-7212
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Country | US
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Telephone | 757-202-2321
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SHANELL RIDDICK
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Credential |
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Telephone | 757-202-2321
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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 |
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License Number State |
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