Provider Demographics
NPI:1376164004
Name:GREATER LOVE INTERNATIONAL
Entity Type:Organization
Organization Name:GREATER LOVE INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MULBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-474-6656
Mailing Address - Street 1:502 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-3113
Mailing Address - Country:US
Mailing Address - Phone:215-966-9388
Mailing Address - Fax:484-494-6232
Practice Address - Street 1:502 S 3RD ST
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-3113
Practice Address - Country:US
Practice Address - Phone:215-966-9388
Practice Address - Fax:484-494-6232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103592857Medicaid