Healthcare Provider Details

I. General information

NPI: 1376937391
Provider Name (Legal Business Name): LOVE BEHAVIOURAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7106 S 30TH LN
PHOENIX AZ
85041-9314
US

IV. Provider business mailing address

7106 S 30TH LN
PHOENIX AZ
85041-9314
US

V. Phone/Fax

Practice location:
  • Phone: 623-521-5935
  • Fax: 602-675-3792
Mailing address:
  • Phone: 623-521-5935
  • Fax: 602-675-3792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: OLUFEMI OMODARA
Title or Position: OWNER
Credential: RPH
Phone: 623-521-5935