Provider Demographics
NPI:1851079776
Name:GOSPELHEROES LOVECARE SERVICES LLC
Entity Type:Organization
Organization Name:GOSPELHEROES LOVECARE SERVICES LLC
Other - Org Name:GOSPELHEROES LOVECARE SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIBROAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TICHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-294-8080
Mailing Address - Street 1:9600 GOLF LAKES TRL APT 1007
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5012
Mailing Address - Country:US
Mailing Address - Phone:202-294-8080
Mailing Address - Fax:
Practice Address - Street 1:9600 GOLF LAKES TRL APT 1007
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5012
Practice Address - Country:US
Practice Address - Phone:202-294-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)