Provider Demographics
NPI:1588969950
Name:L.O.V.E. COALITION
Entity type:Organization
Organization Name:L.O.V.E. COALITION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICIER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDSEL
Authorized Official - Middle Name:STEPHON
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:404-492-2632
Mailing Address - Street 1:3691 TAMPA TRL SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5307
Mailing Address - Country:US
Mailing Address - Phone:404-492-2632
Mailing Address - Fax:
Practice Address - Street 1:3691 TAMPA TRL SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5307
Practice Address - Country:US
Practice Address - Phone:404-492-2632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty