Provider Demographics
NPI:1912175217
Name:LIFE HEALING CENTER
Entity Type:Organization
Organization Name:LIFE HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHENEVERT
Authorized Official - Suffix:
Authorized Official - Credentials:MAPC, LISAC
Authorized Official - Phone:623-533-5138
Mailing Address - Street 1:7155 W CAMPO BELLO DR
Mailing Address - Street 2:SUITE B160
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8590
Mailing Address - Country:US
Mailing Address - Phone:623-533-5138
Mailing Address - Fax:
Practice Address - Street 1:7155 W CAMPO BELLO DR
Practice Address - Street 2:SUITE B160
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8590
Practice Address - Country:US
Practice Address - Phone:623-533-5138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health