Provider Demographics
NPI:1104580596
Name:SEEDS OF LOVE 1 LLC
Entity type:Organization
Organization Name:SEEDS OF LOVE 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AIMABLE
Authorized Official - Middle Name:SEBA
Authorized Official - Last Name:BYISHIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-202-2573
Mailing Address - Street 1:2701 N 16TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-1264
Mailing Address - Country:US
Mailing Address - Phone:319-202-2573
Mailing Address - Fax:
Practice Address - Street 1:2928 S 97TH LN
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-8525
Practice Address - Country:US
Practice Address - Phone:319-202-2573
Practice Address - Fax:623-777-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities