MEDICARE: LOVING LIFE HOME CARE AGENCY 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	251E00000X	Home Health Agency
2	302R00000X	Health Maintenance Organization	HC4740	NC
3	253Z00000X	In Home Supportive Care 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

General Provider Information

NPI Number	:	1972990687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING LIFE HOME CARE AGENCY INC

Provider Business Mailing Address
First Line	:	510 CANDLEBERRY CT
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-7901
Country	:	US
Telephone Number	:	910-977-4610
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 FORT BRAGG RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-6804
Country	:	US
Telephone Number	:	910-977-4610
Fax Number	:	910-339-0047

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. WALONDA ANDRELA OWENS
Credential	:
Telephone Number	:	910-977-4610

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	03/03/2022

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