Provider Demographics
NPI:1134627300
Name:LOVE 1ST, LLC
Entity type:Organization
Organization Name:LOVE 1ST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALETHA
Authorized Official - Middle Name:ROBERTA
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-421-4279
Mailing Address - Street 1:6919 BRYANBELL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23234-8001
Mailing Address - Country:US
Mailing Address - Phone:716-421-4279
Mailing Address - Fax:
Practice Address - Street 1:16317 HAMILTON ARMS RD
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:VA
Practice Address - Zip Code:23840-3105
Practice Address - Country:US
Practice Address - Phone:716-421-4279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3323251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services