Provider Demographics
NPI:1508535725
Name:LOVE & LIGHT HOME CARE LLC
Entity Type:Organization
Organization Name:LOVE & LIGHT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DE'BRYANT
Authorized Official - Middle Name:
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:804-892-2134
Mailing Address - Street 1:4401 WIDGEON CT
Mailing Address - Street 2:
Mailing Address - City:NORTH DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23803-6883
Mailing Address - Country:US
Mailing Address - Phone:804-504-5483
Mailing Address - Fax:804-203-4916
Practice Address - Street 1:4401 WIDGEON CT
Practice Address - Street 2:
Practice Address - City:NORTH DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23803-6883
Practice Address - Country:US
Practice Address - Phone:804-504-5483
Practice Address - Fax:804-203-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities