MEDICARE: LOVING HEARTS 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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2549040	OTHER	OH	PROVIDER NUMBER

General Provider Information

NPI Number	:	1699362194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING HEARTS LLC

Provider Business Mailing Address
First Line	:	2461 MELROSE AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43211-1741
Country	:	US
Telephone Number	:	614-483-7263
Fax Number	:

Provider Business Practice Location Address
First Line	:	2461 MELROSE AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43211-1741
Country	:	US
Telephone Number	:	614-483-7263
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DORREETHA ANN IRBY
Credential	:
Telephone Number	:	614-483-7263

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	12/30/2020

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Directions to “LOVING HEARTS LLC ” Practice Location

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