Provider Demographics
NPI:1386155448
Name:THE LOVE WARRIOR, INC
Entity type:Organization
Organization Name:THE LOVE WARRIOR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LOVE WARRIOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, RYT, MED, M3
Authorized Official - Phone:773-354-4553
Mailing Address - Street 1:1809 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2232
Mailing Address - Country:US
Mailing Address - Phone:773-354-4553
Mailing Address - Fax:
Practice Address - Street 1:1809 LINCOLN
Practice Address - Street 2:GREEN BAY RD ENTRANCE
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:773-354-4553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.019511225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty