Provider Demographics
NPI:1659166320
Name:INNERSOUL LLC
Entity type:Organization
Organization Name:INNERSOUL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARGUILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-316-5779
Mailing Address - Street 1:760 W LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4471
Mailing Address - Country:US
Mailing Address - Phone:619-316-5779
Mailing Address - Fax:602-801-3543
Practice Address - Street 1:760 W LOCUST DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4471
Practice Address - Country:US
Practice Address - Phone:619-316-5779
Practice Address - Fax:602-801-3543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility