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General NPI Number Information
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NPI Number | 1508535725
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Entity Type | Organization
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Legal Business Name | LOVE & LIGHT HOME CARE LLC
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Dates
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Enumeration Date | 09/10/2021
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Last Update Date | 11/02/2021
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Provider Practice Location Address
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Address Line | 4401 WIDGEON CT
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City | NORTH DINWIDDIE
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State | VA
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Zip | 23803-6883
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Country | US
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Telephone | 804-504-5483
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Fax | 804-203-4916
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Provider Business Mailing Address
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Address Line | 4401 WIDGEON CT
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City | NORTH DINWIDDIE
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State | VA
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Zip | 23803-6883
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Country | US
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Telephone | 804-504-5483
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Fax | 804-203-4916
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Authorized Official
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Title or Position | OWNER
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Name | MR. DE'BRYANT MABRY SR.
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Credential |
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Telephone | 804-892-2134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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