=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639578016
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOVINGHANDS4U, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2014
-----------------------------------------------------
Last Update Date | 08/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5504 PEPPERCORN DR
-----------------------------------------------------
City | BURKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22015-1829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-501-1091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5504 PEPPERCORN DR
-----------------------------------------------------
City | BURKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22015-1829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-501-1091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SANDRA DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 571-501-1091
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | B14-448745
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------