Provider Demographics
NPI:1871184077
Name:ALL MINDS CRAVE SUCCESS LLC
Entity Type:Organization
Organization Name:ALL MINDS CRAVE SUCCESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRESHA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:480-810-5419
Mailing Address - Street 1:4616 N 51ST AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-1720
Mailing Address - Country:US
Mailing Address - Phone:480-810-5419
Mailing Address - Fax:
Practice Address - Street 1:4616 N 51ST AVE STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1720
Practice Address - Country:US
Practice Address - Phone:480-810-5419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-30
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health