1659413979 NPI number — NATURAL LIFE CENTERS, LTD.

Table of content: (NPI 1659413979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659413979 NPI number — NATURAL LIFE CENTERS, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATURAL LIFE CENTERS, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659413979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2830 W NORTHERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85051-6626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-864-0036
Provider Business Mailing Address Fax Number:
602-864-0065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10723 W INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVONDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85323-5636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-848-6991
Provider Business Practice Location Address Fax Number:
623-848-6993
Provider Enumeration Date:
02/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WOOLF
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
CHIEF OF STAFF
Authorized Official Telephone Number:
602-864-0036

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4228 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AZ0232770 . This is a "BCBS OF ARIZONA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".