Provider Demographics
NPI:1376258830
Name:LIVE LEARN HOPE SERVICES
Entity Type:Organization
Organization Name:LIVE LEARN HOPE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRISA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-771-7815
Mailing Address - Street 1:940 E BROOKE PL
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-2439
Mailing Address - Country:US
Mailing Address - Phone:520-771-7815
Mailing Address - Fax:612-545-3368
Practice Address - Street 1:5551 34TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2117
Practice Address - Country:US
Practice Address - Phone:612-217-7199
Practice Address - Fax:612-545-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA478492500Medicaid