Provider Demographics
NPI:1083365258
Name:LIVING ABOVE EXPECTATIONS HEALTHCARE LLC.
Entity Type:Organization
Organization Name:LIVING ABOVE EXPECTATIONS HEALTHCARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-675-2177
Mailing Address - Street 1:4045 E UNION HILLS DR STE A109
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3386
Mailing Address - Country:US
Mailing Address - Phone:602-675-2177
Mailing Address - Fax:602-675-3025
Practice Address - Street 1:4045 E UNION HILLS DR STE A109
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3386
Practice Address - Country:US
Practice Address - Phone:602-675-2177
Practice Address - Fax:602-675-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251B00000XAgenciesCase Management