Provider Demographics
NPI:1144034992
Name:LIVE LIFE IN FULL BLOOM TOO LLC
Entity type:Organization
Organization Name:LIVE LIFE IN FULL BLOOM TOO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JANES
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP-A, CSAC-A
Authorized Official - Phone:804-933-8357
Mailing Address - Street 1:2615 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2425
Mailing Address - Country:US
Mailing Address - Phone:804-933-8357
Mailing Address - Fax:
Practice Address - Street 1:7277 HANOVER GREEN DR STE A2
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1764
Practice Address - Country:US
Practice Address - Phone:804-933-8357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty