Provider Demographics
NPI:1346937265
Name:LOVE & LIFE WELLNESS, LLC.
Entity Type:Organization
Organization Name:LOVE & LIFE WELLNESS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:
Authorized Official - First Name:WALETTRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-397-7104
Mailing Address - Street 1:3900 FORD RD PH D
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 FORD RD PH D
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-2045
Practice Address - Country:US
Practice Address - Phone:215-397-7104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service