Provider Demographics
NPI:1134817265
Name:LAVENDER FOUNDATION OF LOVE
Entity type:Organization
Organization Name:LAVENDER FOUNDATION OF LOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ZUHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:FADL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-581-1588
Mailing Address - Street 1:9820 N 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-2411
Mailing Address - Country:US
Mailing Address - Phone:602-581-1588
Mailing Address - Fax:
Practice Address - Street 1:9820 N 49TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-2411
Practice Address - Country:US
Practice Address - Phone:602-581-1588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAVENDER FOUNDATION OF LOVE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No273Y00000XHospital UnitsRehabilitation UnitGroup - Multi-Specialty
No276400000XHospital UnitsRehabilitation, Substance Use Disorder UnitGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty