MEDICARE: GOD'S LOVE, 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	251V00000X	Voluntary or Charitable Agency	08011904	IN

General Provider Information

NPI Number	:	1801046560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOD'S LOVE, INC.

Provider Business Mailing Address
First Line	:	2325 PEBBLE BEACH DR
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-3121
Country	:	US
Telephone Number	:	765-453-2679
Fax Number	:	765-450-8192

Provider Business Practice Location Address
First Line	:	2325 PEBBLE BEACH DR
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46902-3121
Country	:	US
Telephone Number	:	765-453-2679
Fax Number	:	765-450-8192

Authorized Official
Title or Position	:	CEO
Name	:	MRS. LATASHA MICHELLE PRIDE
Credential	:
Telephone Number	:	765-453-2679

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	09/30/2008

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Directions to “GOD'S LOVE, INC. ” Practice Location

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