MEDICARE: LOVE LIFE FOOD 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	367A00000X	Advanced Practice Midwife

General Provider Information

NPI Number	:	1477210938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVE LIFE FOOD LLC

Provider Business Mailing Address
First Line	:	175 W COHAWKIN RD STE C
Second Line	:
City	:	CLARKSBORO
State	:	NJ
Zip	:	08020-1145
Country	:	US
Telephone Number	:	856-423-7700
Fax Number	:	856-423-0823

Provider Business Practice Location Address
First Line	:	6601 VENTNOR AVE STE 12
Second Line	:
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-2172
Country	:	US
Telephone Number	:	609-425-7346
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SHARIE G HILLER
Credential	:	CNM
Telephone Number	:	609-425-7346

Provider Enumeration Date	:	11/19/2021
Last Update Date	:	11/19/2021

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Directions to “LOVE LIFE FOOD LLC ” Practice Location

Language	Start Address	Practice Location

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