Provider Demographics
NPI:1740989581
Name:TOTAL LOVE CARE HEALTH LLC
Entity type:Organization
Organization Name:TOTAL LOVE CARE HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMENTA
Authorized Official - Suffix:
Authorized Official - Credentials:CPB
Authorized Official - Phone:228-334-6609
Mailing Address - Street 1:1526 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-3618
Mailing Address - Country:US
Mailing Address - Phone:228-357-0912
Mailing Address - Fax:228-678-2248
Practice Address - Street 1:1526 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-3618
Practice Address - Country:US
Practice Address - Phone:228-357-0912
Practice Address - Fax:228-678-2248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty