Provider Demographics
NPI:1831490416
Name:LOVE ASSISTED LIVING
Entity Type:Organization
Organization Name:LOVE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER ( C.E.O )
Authorized Official - Prefix:MS
Authorized Official - First Name:LOVENESS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMUYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-423-0437
Mailing Address - Street 1:8706 OXWELL LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8706 OXWELL LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708
Practice Address - Country:US
Practice Address - Phone:240-423-0437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC320600000X
320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities