MEDICARE: LOVE & LOYALTY 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
2	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number	:	1891273454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVE & LOYALTY LLC

Provider Business Mailing Address
First Line	:	6025 GUM SPRINGS ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6778
Country	:	US
Telephone Number	:	702-980-6599
Fax Number	:

Provider Business Practice Location Address
First Line	:	6025 GUM SPRINGS ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6778
Country	:	US
Telephone Number	:	702-980-6599
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS RODNESHIA CARTER
Credential	:
Telephone Number	:	702-980-6599

Provider Enumeration Date	:	08/04/2018
Last Update Date	:	08/04/2018

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