Provider Demographics
NPI:1043544802
Name:LETS BE PALS LLC
Entity Type:Organization
Organization Name:LETS BE PALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-497-3245
Mailing Address - Street 1:1849 E GUADALUPE RD STE C101
Mailing Address - Street 2:166
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3281
Mailing Address - Country:US
Mailing Address - Phone:480-497-3245
Mailing Address - Fax:
Practice Address - Street 1:1101 S SYCAMORE
Practice Address - Street 2:323
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4005
Practice Address - Country:US
Practice Address - Phone:480-497-3245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL15454205302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization