Provider Demographics
NPI:1679347108
Name:BIG MOMMY HOME OF LOVE LLC
Entity type:Organization
Organization Name:BIG MOMMY HOME OF LOVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:INDEPENDENT PROVIDER
Authorized Official - Phone:937-608-8470
Mailing Address - Street 1:919 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3914
Mailing Address - Country:US
Mailing Address - Phone:937-608-8470
Mailing Address - Fax:
Practice Address - Street 1:131 N LUDLOW ST STE 212
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1165
Practice Address - Country:US
Practice Address - Phone:937-608-8470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIG MOMMY HOME OF LOVE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health