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General NPI Number Information
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NPI Number | 1104580596
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Entity Type | Organization
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Legal Business Name | SEEDS OF LOVE 1 LLC
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Dates
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Enumeration Date | 10/22/2021
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 2928 S 97TH LN
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City | TOLLESON
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State | AZ
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Zip | 85353-8525
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Country | US
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Telephone | 319-202-2573
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Fax | 623-777-0082
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Provider Business Mailing Address
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Address Line | 2701 N 16TH ST STE 108
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City | PHOENIX
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State | AZ
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Zip | 85006-1264
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Country | US
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Telephone | 319-202-2573
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. AIMABLE SEBA BYISHIMO
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Credential |
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Telephone | 319-202-2573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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