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General NPI Number Information
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NPI Number | 1811296205
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Entity Type | Organization
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Legal Business Name | HOUSE OF LOVE FAMILY CARE HOME
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 994 CHICKEN CORNER RD
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-8545
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Country | US
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Telephone | 252-338-6648
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Fax |
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Provider Business Mailing Address
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Address Line | 994 CHICKEN CORNER RD
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City | ELIZABETH CITY
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State | NC
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Zip | 27976
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Country | US
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Telephone | 252-338-6648
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. AMY MOZELA OUTLAW
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Credential |
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Telephone | 252-330-9935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | NC
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