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General NPI Number Information
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NPI Number | 1134627300
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Entity Type | Organization
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Legal Business Name | LOVE 1ST, LLC
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 16317 HAMILTON ARMS RD
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City | DEWITT
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State | VA
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Zip | 23840-3105
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Country | US
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Telephone | 716-421-4279
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Fax |
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Provider Business Mailing Address
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Address Line | 6919 BRYANBELL DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23234-8001
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Country | US
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Telephone | 716-421-4279
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALETHA ROBERTA CLARK
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Credential |
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Telephone | 716-421-4279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 3323
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License Number State | VA
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