MEDICARE: LOVE IN ACTION (LIA) HOME HEALTH CARE 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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1679288807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVE IN ACTION (LIA) HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	1127 QUEENSDOWN WAY
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-3579
Country	:	US
Telephone Number	:	336-471-3394
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 QUEENSDOWN WAY
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-3579
Country	:	US
Telephone Number	:	336-471-3394
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM MANAGER
Name	:	SAMMY O AYODELE
Credential	:	RN
Telephone Number	:	336-471-3394

Provider Enumeration Date	:	01/23/2023
Last Update Date	:	01/23/2023

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