=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841829470
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRACE LOVING ARMS PRIVATE SITTING SERVICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2020
-----------------------------------------------------
Last Update Date | 04/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50290 OLLER RD
-----------------------------------------------------
City | TICKFAW
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70466-3228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-289-0501
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50290 OLLER RD
-----------------------------------------------------
City | TICKFAW
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70466-3228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-289-0501
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROSITA ANN ROBINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 504-289-0501
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------