=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346851482
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LADY BUGS COMPASSIONATE CAREGIVERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2020
-----------------------------------------------------
Last Update Date | 08/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 HIGHLAND PARK DR
-----------------------------------------------------
City | LEVITTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19056-1338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-954-8942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 HIGHLAND PARK DR
-----------------------------------------------------
City | LEVITTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19056-1338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-954-8942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. OCTAVIA DOUGLAS
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 908-954-8942
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------