Healthcare Provider Details

I. General information

NPI: 1326819178
Provider Name (Legal Business Name): FIRST LOVE BEHAVIORAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 S 165TH DR
GOODYEAR AZ
85338-4590
US

IV. Provider business mailing address

817 S 165TH DR
GOODYEAR AZ
85338-4590
US

V. Phone/Fax

Practice location:
  • Phone: 602-501-1389
  • Fax:
Mailing address:
  • Phone: 602-501-1389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: GUADALUPE E FIERRO VALDEZ
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 602-501-1389