Provider Demographics
NPI:1194095224
Name:HOUSE LOVE LLC
Entity type:Organization
Organization Name:HOUSE LOVE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:CAREGIVER
Authorized Official - Phone:202-422-7733
Mailing Address - Street 1:9813 JACQUELINE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-2526
Mailing Address - Country:US
Mailing Address - Phone:301-248-6151
Mailing Address - Fax:240-244-1147
Practice Address - Street 1:2804 CRICKLEWOOD DR
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-2411
Practice Address - Country:US
Practice Address - Phone:201-265-0143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSE OF LOVE, II
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16AL548310400000X, 3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility