Provider Demographics
NPI:1033652318
Name:DESTINED FOR LOVE LLC
Entity Type:Organization
Organization Name:DESTINED FOR LOVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JADEA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-515-9669
Mailing Address - Street 1:737 EMILE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWEGO
Mailing Address - State:LA
Mailing Address - Zip Code:70094
Mailing Address - Country:US
Mailing Address - Phone:504-515-9669
Mailing Address - Fax:
Practice Address - Street 1:737 EMILE AVE
Practice Address - Street 2:
Practice Address - City:WESTWEGO
Practice Address - State:LA
Practice Address - Zip Code:70094-4009
Practice Address - Country:US
Practice Address - Phone:504-515-9669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health