Provider Demographics
NPI:1346994894
Name:LOVE, PORSCHA (CNA MA)
Entity Type:Individual
Prefix:
First Name:PORSCHA
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:CNA MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 BLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-3519
Mailing Address - Country:US
Mailing Address - Phone:812-249-9382
Mailing Address - Fax:
Practice Address - Street 1:1600 BLAINE AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-3519
Practice Address - Country:US
Practice Address - Phone:812-223-3281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN87-2592440OtherNON MEDICAL