Provider Demographics
NPI:1538409040
Name:LOVING HEALTH CARE , LLC
Entity type:Organization
Organization Name:LOVING HEALTH CARE , LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:KIMPLE
Authorized Official - Last Name:ELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-354-7866
Mailing Address - Street 1:931 HIGHWAY 80 W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3912
Mailing Address - Country:US
Mailing Address - Phone:601-354-7866
Mailing Address - Fax:
Practice Address - Street 1:931 HIGHWAY 80 W
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3912
Practice Address - Country:US
Practice Address - Phone:601-354-7866
Practice Address - Fax:601-354-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04920770253Z00000X
MS03652350343900000X
MS06979709253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06979709Medicaid