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General NPI Number Information
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NPI Number | 1689719650
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Entity Type | Organization
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Legal Business Name | FOR LIFE SERVICES-COMMUNITY CARE, LLC
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 16671 N LITCHFIELD RD APT 223
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City | SURPRISE
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State | AZ
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Zip | 85374-7080
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Country | US
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Telephone | 602-405-4962
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Fax | 702-973-6392
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Provider Business Mailing Address
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Address Line | PO BOX 8222
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City | SURPRISE
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State | AZ
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Zip | 85374-0120
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Country | US
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Telephone | 602-405-4962
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Fax | 702-973-6392
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Authorized Official
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Title or Position | CEO
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Name | DR. TRA AHIA
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Credential | PH. D.
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Telephone | 602-405-4962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | BH 2690
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License Number State | AZ
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