Provider Demographics
NPI:1215538806
Name:LIFE N LOVE WELLNESS INC
Entity Type:Organization
Organization Name:LIFE N LOVE WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRAKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-509-0809
Mailing Address - Street 1:4050 E COTTON CENTER BLVD STE 77
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-8865
Mailing Address - Country:US
Mailing Address - Phone:312-509-0809
Mailing Address - Fax:
Practice Address - Street 1:4050 E COTTON CENTER BLVD STE 77
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-8865
Practice Address - Country:US
Practice Address - Phone:312-509-0809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty