MEDICARE: ONE LOVE PERIODIC SERVICES, INC

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	251B00000X	Case Management Agency
2	253J00000X	Foster Care Agency		NC
3	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	MHL-012-095	NC
4	253J00000X	Foster Care Agency
5	101YP2500X	Professional Counselor
6	2084P0800X	Psychiatry Physician
7	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710275409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE LOVE PERIODIC SERVICES, INC

Provider Business Mailing Address
First Line	:	103 NORTH GREEN STREET
Second Line	:
City	:	MORGANTON
State	:	NC
Zip	:	28655-3483
Country	:	US
Telephone Number	:	828-433-4567
Fax Number	:	828-433-4576

Provider Business Practice Location Address
First Line	:	103 N GREEN ST
Second Line	:
City	:	MORGANTON
State	:	NC
Zip	:	28655-3466
Country	:	US
Telephone Number	:	828-433-4567
Fax Number	:	828-433-4576

Authorized Official
Title or Position	:	CEO
Name	:	STEVIE LYNN WIDEMAN
Credential	:
Telephone Number	:	828-433-4567

Provider Enumeration Date	:	07/14/2011
Last Update Date	:	07/21/2022

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Directions to “ONE LOVE PERIODIC SERVICES, INC ” Practice Location

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