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General NPI Number Information
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NPI Number | 1861260291
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Entity Type | Organization
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Legal Business Name | HOUSE OF LOVE LLC
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Dates
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Enumeration Date | 12/14/2023
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 45657 W MORNING VIEW LN
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City | MARICOPA
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State | AZ
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Zip | 85139-6665
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Country | US
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Telephone | 602-756-5564
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Fax |
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Provider Business Mailing Address
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Address Line | 3122 E ROESER RD APT 1
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City | PHOENIX
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State | AZ
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Zip | 85040-3738
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Country | US
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Telephone | 602-756-5564
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALBERTA WATKINS
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Credential | BH ADMINISTRATOR
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Telephone | 160-275-6556
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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 |
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License Number State |
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