Provider Demographics
NPI:1306517495
Name:LOVE AND ACTION CENTER LLC
Entity type:Organization
Organization Name:LOVE AND ACTION CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLTRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-699-2819
Mailing Address - Street 1:PO BOX 79113
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27417-9113
Mailing Address - Country:US
Mailing Address - Phone:336-699-2819
Mailing Address - Fax:336-299-9758
Practice Address - Street 1:3811 REPON ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-5536
Practice Address - Country:US
Practice Address - Phone:336-699-2819
Practice Address - Fax:336-299-9758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty