Provider Demographics
NPI:1972143451
Name:AGING WITH LOVE LLC
Entity type:Organization
Organization Name:AGING WITH LOVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-667-4957
Mailing Address - Street 1:3134 WHITEHEAD LN
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-7200
Mailing Address - Country:US
Mailing Address - Phone:813-417-1128
Mailing Address - Fax:866-470-3118
Practice Address - Street 1:111 PENN BLVD STE B
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2626
Practice Address - Country:US
Practice Address - Phone:215-667-4957
Practice Address - Fax:481-461-4598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health