# SEEDS OF GAIA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063802205
- **Authorized official:** MR. MOISE KELLY (PRESIDENT)
- **Authorized official phone:** (480) 277-0313

## Contact information

- **Practice address:** 455 S MESA DR UNIT 142, MESA, AZ 85210-2711
- **Practice address phone:** (480) 277-0313
- **Mailing address:** PO BOX 4252, MESA, AZ 85211-4252
- **Mailing address phone:** (480) 277-0313

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | L-1744233-1 | AZ | Yes |

## Other

- **Enumeration date:** 01/26/2015
- **Last updated:** 01/26/2015