Provider Demographics
NPI:1518235050
Name:LOVING IMAGE HEALTH SERVICES
Entity Type:Organization
Organization Name:LOVING IMAGE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:TYISIHA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-613-4687
Mailing Address - Street 1:971 HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1912
Mailing Address - Country:US
Mailing Address - Phone:203-212-8417
Mailing Address - Fax:
Practice Address - Street 1:971 HANCOCK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1912
Practice Address - Country:US
Practice Address - Phone:203-212-8417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health