Provider Demographics
NPI:1093305849
Name:LOVING MOTHER RESIDENCY, LLC
Entity Type:Organization
Organization Name:LOVING MOTHER RESIDENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATUTORY AGENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIZARDE
Authorized Official - Middle Name:TORNO
Authorized Official - Last Name:ESTRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-231-9713
Mailing Address - Street 1:629 N ENTRADA ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2204
Mailing Address - Country:US
Mailing Address - Phone:667-231-9713
Mailing Address - Fax:
Practice Address - Street 1:629 N ENTRADA ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2204
Practice Address - Country:US
Practice Address - Phone:480-702-0037
Practice Address - Fax:480-702-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility