Provider Demographics
NPI:1104514801
Name:AWAITING GREATNESS LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:AWAITING GREATNESS LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:ARSEAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-983-3056
Mailing Address - Street 1:12042 W FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-7225
Mailing Address - Country:US
Mailing Address - Phone:615-983-3056
Mailing Address - Fax:
Practice Address - Street 1:3940 APACHE TRL
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3400
Practice Address - Country:US
Practice Address - Phone:615-983-3056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management