Provider Demographics
NPI:1164070819
Name:LOVE SHINES BEHAVIORAL HEALTH HOMES LLC
Entity Type:Organization
Organization Name:LOVE SHINES BEHAVIORAL HEALTH HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-334-5668
Mailing Address - Street 1:16401 N 39TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3246
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16401 N 39TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3246
Practice Address - Country:US
Practice Address - Phone:949-630-1715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOVE SHINES BEHAVIORAL HEALTH HOMES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-27
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home