Provider Demographics
NPI:1417774779
Name:LOVE AND LIGHT SENIOR CARE LLC
Entity type:Organization
Organization Name:LOVE AND LIGHT SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALM
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHONNET
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-515-1789
Mailing Address - Street 1:17609 CLINTON DR
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3406
Mailing Address - Country:US
Mailing Address - Phone:202-515-1789
Mailing Address - Fax:240-250-0050
Practice Address - Street 1:17609 CLINTON DR
Practice Address - Street 2:
Practice Address - City:ACCOKEEK
Practice Address - State:MD
Practice Address - Zip Code:20607-3406
Practice Address - Country:US
Practice Address - Phone:202-515-1789
Practice Address - Fax:240-250-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness