=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316649742
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL WE NEED IS LOVE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2023
-----------------------------------------------------
Last Update Date | 03/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5340 KIRKLAND AVE
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-646-9255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5340 KIRKLAND AVE
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-646-9255
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICESEE
-----------------------------------------------------
Name | BUENOMIR MIRABUENO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-646-9252
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------