Provider Demographics
NPI:1316834500
Name:LOVE, LAILA CHANEL
Entity type:Individual
Prefix:MS
First Name:LAILA
Middle Name:CHANEL
Last Name:LOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 1/2 N LONDON ST APT C
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:OH
Mailing Address - Zip Code:43143-1116
Mailing Address - Country:US
Mailing Address - Phone:702-787-0507
Mailing Address - Fax:702-787-0507
Practice Address - Street 1:10400 BLACKLICK RD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8235
Practice Address - Country:US
Practice Address - Phone:614-726-7359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0487170Medicaid