MEDICARE: LIVE LIFE IN FULL BLOOM TOO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1144034992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE LIFE IN FULL BLOOM TOO LLC

Provider Business Mailing Address
First Line	:	2615 OAK HILL RD
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2425
Country	:	US
Telephone Number	:	804-933-8357
Fax Number	:

Provider Business Practice Location Address
First Line	:	7277 HANOVER GREEN DR STE A2
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-1764
Country	:	US
Telephone Number	:	804-933-8357
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIELLE JANES
Credential	:	QMHP-A, CSAC-A
Telephone Number	:	804-933-8357

Provider Enumeration Date	:	02/03/2025
Last Update Date	:	01/20/2026

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