Provider Demographics
NPI:1457720443
Name:CHRISTIAN LOVE AND TOUCH GROUP HOME LLC
Entity Type:Organization
Organization Name:CHRISTIAN LOVE AND TOUCH GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-206-5815
Mailing Address - Street 1:165 CAROL SUSAN LN
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-8340
Mailing Address - Country:US
Mailing Address - Phone:772-206-5815
Mailing Address - Fax:
Practice Address - Street 1:165 CAROL SUSAN LN
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-8340
Practice Address - Country:US
Practice Address - Phone:772-206-5815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-19
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty