Provider Demographics
NPI:1780405712
Name:LIVE LAUGH LOVE CLUB
Entity type:Organization
Organization Name:LIVE LAUGH LOVE CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-444-9070
Mailing Address - Street 1:1202 N FLORES ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1202 N FLORES ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4923
Practice Address - Country:US
Practice Address - Phone:210-444-9070
Practice Address - Fax:210-485-2489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services