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General NPI Number Information
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NPI Number | 1417441841
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Entity Type | Organization
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Legal Business Name | LOVE AND GLORY SERVICES LLC
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Dates
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Enumeration Date | 06/19/2018
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 664 LAWLER ST
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3336
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Country | US
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Telephone | 215-667-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 664 LAWLER ST
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3336
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Country | US
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Telephone | 215-667-4200
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MATHEW SAMUEL
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Credential |
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Telephone | 215-667-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 103484303-0001
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License Number State | PA
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