MEDICARE: LOVE, LIGHT AND LIBERTY MINISTRIES

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	LC301442	DC
2	251S00000X	Community/Behavioral Health Agency	LC301442	DC

General Provider Information

NPI Number	:	1952638843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVE, LIGHT AND LIBERTY MINISTRIES

Provider Business Mailing Address
First Line	:	1425 K ST NW
Second Line	:	SUITE 350
City	:	WASHINGTON
State	:	DC
Zip	:	20005-3500
Country	:	US
Telephone Number	:	202-587-2732
Fax Number	:	202-587-5601

Provider Business Practice Location Address
First Line	:	1425 K ST NW
Second Line	:	SUITE 350
City	:	WASHINGTON
State	:	DC
Zip	:	20005-3500
Country	:	US
Telephone Number	:	202-587-2732
Fax Number	:	202-587-5601

Authorized Official
Title or Position	:	PASTOR/FOUNDER
Name	:	MR. CLINTON JONATHAN ANDERSON
Credential	:
Telephone Number	:	202-587-2732

Provider Enumeration Date	:	11/12/2009
Last Update Date	:	11/12/2009

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Directions to “LOVE, LIGHT AND LIBERTY MINISTRIES ” Practice Location

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