Organization
SEEDS OF GAIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOISE KELLY (PRESIDENT)
(480) 277-0313
Entity
Organization
Contact information
Practice address
455 S MESA DR UNIT 142, MESA, AZ 85210-2711
(480) 277-0313
Mailing address
PO BOX 4252, MESA, AZ 85211-4252
(480) 277-0313
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
L-1744233-1
AZ
Other
Enumeration date
01/26/2015
Last updated
01/26/2015
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