Provider Demographics
NPI:1790384030
Name:GREAT XPECTATIONS LLC
Entity Type:Organization
Organization Name:GREAT XPECTATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ORANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-406-2313
Mailing Address - Street 1:14955 W BELL RD UNIT 9108
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8286
Mailing Address - Country:US
Mailing Address - Phone:480-406-2313
Mailing Address - Fax:
Practice Address - Street 1:4014 W CHRISTY DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3958
Practice Address - Country:US
Practice Address - Phone:480-406-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities