Provider Demographics
NPI:1316453913
Name:LOVE FOR THE CHILDREN GROUP HOME
Entity type:Organization
Organization Name:LOVE FOR THE CHILDREN GROUP HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-717-1821
Mailing Address - Street 1:17932 W DESERT LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-1658
Mailing Address - Country:US
Mailing Address - Phone:310-717-1821
Mailing Address - Fax:623-444-8314
Practice Address - Street 1:20277 N 93RD AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5319
Practice Address - Country:US
Practice Address - Phone:310-717-1821
Practice Address - Fax:623-444-8413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH5297OtherAZDHS
AZBH5297OtherAZDHS
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