Provider Demographics
NPI:1144817214
Name:HOUSE OF LOVE RESIDENTIAL FACILITY LLC
Entity type:Organization
Organization Name:HOUSE OF LOVE RESIDENTIAL FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-846-6767
Mailing Address - Street 1:PO BOX 1984
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-1984
Mailing Address - Country:US
Mailing Address - Phone:562-846-6767
Mailing Address - Fax:
Practice Address - Street 1:4138 E NIGHTHAWK WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0556
Practice Address - Country:US
Practice Address - Phone:562-846-6767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness