Provider Demographics
NPI:1124862412
Name:LOVE AND LIGHT CARE SERVICES
Entity type:Organization
Organization Name:LOVE AND LIGHT CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-960-7507
Mailing Address - Street 1:140 E BROADWAY ST # 176
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-1758
Mailing Address - Country:US
Mailing Address - Phone:317-960-7507
Mailing Address - Fax:
Practice Address - Street 1:140 E BROADWAY ST # 176
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1758
Practice Address - Country:US
Practice Address - Phone:317-960-7507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty