Provider Demographics
NPI:1740067933
Name:HOME OF LOVE, LLC
Entity type:Organization
Organization Name:HOME OF LOVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:KWABENA
Authorized Official - Last Name:AMOAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-558-6531
Mailing Address - Street 1:30973 N KAREN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-3358
Mailing Address - Country:US
Mailing Address - Phone:480-558-6531
Mailing Address - Fax:
Practice Address - Street 1:32088 N LISADRE LN
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85144-0035
Practice Address - Country:US
Practice Address - Phone:480-243-7140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health