Provider Demographics
NPI:1558060525
Name:LOYAL SOURCE GOVERNMENT SERVICES LLC
Entity Type:Organization
Organization Name:LOYAL SOURCE GOVERNMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE & CONTRACTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALINA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:LABADESSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-605-6427
Mailing Address - Street 1:12612 CHALLENGER PKWY STE 365
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-2784
Mailing Address - Country:US
Mailing Address - Phone:407-605-6427
Mailing Address - Fax:
Practice Address - Street 1:2800 N TENAYA WAY STE 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1100
Practice Address - Country:US
Practice Address - Phone:725-231-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty