Provider Demographics
NPI:1962052266
Name:LIVING 365 LLC
Entity type:Organization
Organization Name:LIVING 365 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-248-4342
Mailing Address - Street 1:11250 E QUICKSILVER AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-4005
Mailing Address - Country:US
Mailing Address - Phone:803-600-6939
Mailing Address - Fax:
Practice Address - Street 1:2267 S 173RD DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1961
Practice Address - Country:US
Practice Address - Phone:623-248-4342
Practice Address - Fax:623-248-6096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty
No174200000XOther Service ProvidersMealsGroup - Single Specialty
No177F00000XOther Service ProvidersLodging
No251J00000XAgenciesNursing Care
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility