Provider Demographics
NPI:1457165136
Name:LOVE COMMUNITY BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:LOVE COMMUNITY BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-550-5028
Mailing Address - Street 1:112 MEADOWCREST DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-6749
Mailing Address - Country:US
Mailing Address - Phone:618-550-5028
Mailing Address - Fax:
Practice Address - Street 1:112 MEADOWCREST DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-6749
Practice Address - Country:US
Practice Address - Phone:618-550-5028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health