Provider Demographics
NPI:1689148512
Name:ARIZONA LOVE AND CARE LLC
Entity Type:Organization
Organization Name:ARIZONA LOVE AND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JARVIS
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:623-570-3723
Mailing Address - Street 1:15250 W PIERSON ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7734
Mailing Address - Country:US
Mailing Address - Phone:623-777-1110
Mailing Address - Fax:623-921-4750
Practice Address - Street 1:15250 W PIERSON ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7734
Practice Address - Country:US
Practice Address - Phone:623-777-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health