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General NPI Number Information
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NPI Number | 1326469719
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Entity Type | Organization
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Legal Business Name | A MOTHERS LOVE RESIDENTIAL HOMES LLC
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 01/02/2014
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Provider Practice Location Address
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Address Line | 11610 W WINDROSE AVE
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City | EL MIRAGE
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State | AZ
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Zip | 85335-3951
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Country | US
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Telephone | 623-792-5336
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Fax | 602-926-8174
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Provider Business Mailing Address
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Address Line | 11610 W WINDROSE AVE
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City | EL MIRAGE
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State | AZ
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Zip | 85335-3951
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Country | US
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Telephone | 623-792-5336
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Fax | 602-926-8174
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Authorized Official
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Title or Position | CHIEF EXECECUTIVE OFFICER
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Name | TRACEY MILLER
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Credential |
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Telephone | 623-792-5336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | BH4352
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License Number State | AZ
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