Provider Demographics
NPI:1780024992
Name:LISA'S HOUSE OF LOVE LLC
Entity Type:Organization
Organization Name:LISA'S HOUSE OF LOVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE AID
Authorized Official - Phone:770-896-8740
Mailing Address - Street 1:2685 MORRIS ST NW
Mailing Address - Street 2:UNIT 2
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-4542
Mailing Address - Country:US
Mailing Address - Phone:770-896-8740
Mailing Address - Fax:
Practice Address - Street 1:2685 MORRIS ST NW
Practice Address - Street 2:UNIT 2
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4542
Practice Address - Country:US
Practice Address - Phone:770-896-8740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care