Provider Demographics
NPI:1679288807
Name:LOVE IN ACTION (LIA) HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:LOVE IN ACTION (LIA) HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:O
Authorized Official - Last Name:AYODELE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:336-471-3394
Mailing Address - Street 1:1127 QUEENSDOWN WAY
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-3579
Mailing Address - Country:US
Mailing Address - Phone:336-471-3394
Mailing Address - Fax:
Practice Address - Street 1:1127 QUEENSDOWN WAY
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-3579
Practice Address - Country:US
Practice Address - Phone:336-471-3394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care