Provider Demographics
NPI:1083263123
Name:LOVE 4 LIFE ABA LLC.
Entity Type:Organization
Organization Name:LOVE 4 LIFE ABA LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:RIXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-225-9725
Mailing Address - Street 1:356 MCKAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1504
Mailing Address - Country:US
Mailing Address - Phone:321-225-9725
Mailing Address - Fax:
Practice Address - Street 1:6608 S WEST SHORE BLVD APT 2224
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33616-1563
Practice Address - Country:US
Practice Address - Phone:321-225-9725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty