MEDICARE: THE HOUSE OF L.U.V. (LIFE IS UNIQUE & VALUABLE) 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		NC

General Provider Information

NPI Number	:	1669849873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HOUSE OF L.U.V. (LIFE IS UNIQUE & VALUABLE) LLC

Provider Business Mailing Address
First Line	:	3203 MEADOW LN
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-3611
Country	:	US
Telephone Number	:	336-480-5115
Fax Number	:

Provider Business Practice Location Address
First Line	:	3203 MEADOW LN
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-3611
Country	:	US
Telephone Number	:	336-480-5115
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID BROWN
Credential	:
Telephone Number	:	336-480-5115

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	11/24/2021

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