MEDICARE: LOV JOY SENIOR LIVING 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	311ZA0620X	Adult Care Home Facility	2016-263838-R	VA

General Provider Information

NPI Number	:	1972960417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOV JOY SENIOR LIVING LLC

Provider Business Mailing Address
First Line	:	6021 CLEAR SPRINGS RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4637
Country	:	US
Telephone Number	:	410-530-0088
Fax Number	:

Provider Business Practice Location Address
First Line	:	6021 CLEAR SPRINGS RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4637
Country	:	US
Telephone Number	:	410-530-0088
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. LORRIE ANN NICHOLS
Credential	:	MT, PCT, GNA
Telephone Number	:	410-530-0088

Provider Enumeration Date	:	01/27/2016
Last Update Date	:	01/27/2016

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