1407325764 NPI number — LOVE FAMILY PRACTICE

Table of content: (NPI 1407325764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407325764 NPI number — LOVE FAMILY PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
LOVE FAMILY PRACTICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407325764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6632 HALLWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22046-1825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-542-7131
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1629 K ST NW STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20006-1631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-876-2873
Provider Business Practice Location Address Fax Number:
202-876-2873
Provider Enumeration Date:
11/16/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALSGAARD
Authorized Official First Name:
JUNE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
703-542-7131

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)