Healthcare Provider Details

I. General information

NPI: 1245172899
Provider Name (Legal Business Name): GIFTED LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E PIEDMONT RD
PHOENIX AZ
85042-8419
US

IV. Provider business mailing address

610 E PIEDMONT RD
PHOENIX AZ
85042-8419
US

V. Phone/Fax

Practice location:
  • Phone: 602-799-3597
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. STARLA JACKSON
Title or Position: PROVIDER
Credential:
Phone: 602-799-3597