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General NPI Number Information
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NPI Number | 1417774779
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Entity Type | Organization
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Legal Business Name | LOVE AND LIGHT SENIOR CARE LLC
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Dates
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Enumeration Date | 09/26/2024
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 17609 CLINTON DR
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City | ACCOKEEK
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State | MD
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Zip | 20607-3406
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Country | US
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Telephone | 202-515-1789
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Fax | 240-250-0050
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Provider Business Mailing Address
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Address Line | 17609 CLINTON DR
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City | ACCOKEEK
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State | MD
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Zip | 20607-3406
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Country | US
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Telephone | 202-515-1789
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Fax | 240-250-0050
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Authorized Official
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Title or Position | ALM
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Name | MRS. SHONNET LEWIS
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Credential |
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Telephone | 202-515-1789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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