Provider Demographics
NPI:1376937391
Name:LOVE BEHAVIOURAL SERVICES LLC
Entity Type:Organization
Organization Name:LOVE BEHAVIOURAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUFEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OMODARA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:623-521-5935
Mailing Address - Street 1:14435 W VERDE LN
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8335
Mailing Address - Country:US
Mailing Address - Phone:623-521-5935
Mailing Address - Fax:623-264-4288
Practice Address - Street 1:14435 W VERDE LN
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-8335
Practice Address - Country:US
Practice Address - Phone:623-521-5935
Practice Address - Fax:623-264-4288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness