Provider Demographics
NPI:1255617874
Name:L& C HEALTHCARE SERVICES
Entity type:Organization
Organization Name:L& C HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-414-7465
Mailing Address - Street 1:PO BOX 1564
Mailing Address - Street 2:
Mailing Address - City:ARIZONA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85123-1317
Mailing Address - Country:US
Mailing Address - Phone:520-414-7465
Mailing Address - Fax:
Practice Address - Street 1:4902 N LAKESHORE DRIVE
Practice Address - Street 2:SUITE1564
Practice Address - City:ARIZONA CITY
Practice Address - State:AZ
Practice Address - Zip Code:85123
Practice Address - Country:US
Practice Address - Phone:520-414-7465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 320700000X
AZ322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========Medicaid