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General NPI Number Information
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NPI Number | 1093248973
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Entity Type | Organization
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Legal Business Name | LOVE AND DIVINE HOME CARE
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 303 OAK CANYON WAY
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City | FOLSOM
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State | CA
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Zip | 95630-1855
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Country | US
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Telephone | 916-932-4883
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Fax |
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Provider Business Mailing Address
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Address Line | 303 OAK CANYON WAY
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City | FOLSOM
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State | CA
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Zip | 95630-1855
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Country | US
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Telephone | 916-932-4883
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LISA M IVANCICH
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Credential |
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Telephone | 916-945-0241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 347005677
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License Number State | CA
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