Provider Demographics
NPI:1912679291
Name:PILLARS OF LIFE LLC
Entity Type:Organization
Organization Name:PILLARS OF LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GENASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-414-3022
Mailing Address - Street 1:43477 W KRAMER LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-8933
Mailing Address - Country:US
Mailing Address - Phone:520-483-4895
Mailing Address - Fax:
Practice Address - Street 1:1515 E FLORENCE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5334
Practice Address - Country:US
Practice Address - Phone:520-414-3022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health