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General NPI Number Information
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NPI Number | 1972990687
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Entity Type | Organization
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Legal Business Name | LOVING LIFE HOME CARE AGENCY INC
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 1811 FORT BRAGG RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-6804
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Country | US
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Telephone | 910-977-4610
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Fax | 910-339-0047
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Provider Business Mailing Address
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Address Line | 510 CANDLEBERRY CT
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-7901
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Country | US
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Telephone | 910-977-4610
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. WALONDA ANDRELA OWENS
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Credential |
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Telephone | 910-977-4610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | HC4740
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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