Provider Demographics
NPI:1447928189
Name:LOVE BEHAVIOURAL SERVICES
Entity type:Organization
Organization Name:LOVE BEHAVIOURAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:OLUFEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OMODARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-521-5935
Mailing Address - Street 1:7106 S. 30TH LANE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041
Mailing Address - Country:US
Mailing Address - Phone:623-521-5935
Mailing Address - Fax:602-441-4838
Practice Address - Street 1:7226 S. 42TH LANE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041
Practice Address - Country:US
Practice Address - Phone:623-521-5935
Practice Address - Fax:602-441-4838
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOVE BEHAVIOURAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness