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General NPI Number Information
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NPI Number | 1962052266
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Entity Type | Organization
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Legal Business Name | LIVING 365 LLC
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 2267 S 173RD DR
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City | GOODYEAR
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State | AZ
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Zip | 85338-1961
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Country | US
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Telephone | 623-248-4342
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Fax | 623-248-6096
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Provider Business Mailing Address
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Address Line | 11250 E QUICKSILVER AVE
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City | MESA
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State | AZ
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Zip | 85212-4005
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Country | US
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Telephone | 803-600-6939
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA MUHAMMAD
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Credential |
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Telephone | 623-248-4342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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