Provider Demographics
NPI:1326469719
Name:A MOTHERS LOVE RESIDENTIAL HOMES LLC
Entity Type:Organization
Organization Name:A MOTHERS LOVE RESIDENTIAL HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-792-5336
Mailing Address - Street 1:11610 W WINDROSE AVE
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-3951
Mailing Address - Country:US
Mailing Address - Phone:623-792-5336
Mailing Address - Fax:602-926-8174
Practice Address - Street 1:11610 W WINDROSE AVE
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-3951
Practice Address - Country:US
Practice Address - Phone:623-792-5336
Practice Address - Fax:602-926-8174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4352322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children