Provider Demographics
NPI:1053661512
Name:LOVE HEALTHY ME, LLC
Entity Type:Organization
Organization Name:LOVE HEALTHY ME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-696-0442
Mailing Address - Street 1:356 MOUNTAIN SMITH ESTS
Mailing Address - Street 2:
Mailing Address - City:COCOLALLA
Mailing Address - State:ID
Mailing Address - Zip Code:83813-6002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:356 MOUNTAIN SMITH ESTS
Practice Address - Street 2:
Practice Address - City:COCOLALLA
Practice Address - State:ID
Practice Address - Zip Code:83813-6002
Practice Address - Country:US
Practice Address - Phone:707-696-0442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID637251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health