Organization
SEEDS OF GAIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
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
251300000X
Local Education Agency (LEA)
957399
AZ
251B00000X
Case Management Agency
957399
AZ
251C00000X
Developmentally Disabled Services Day Training Agency
957399
AZ
251E00000X
Home Health Agency
957399
AZ
251K00000X
Public Health or Welfare Agency
957399
AZ
251S00000X
Community/Behavioral Health Agency
Primary
957399
AZ
252Y00000X
Early Intervention Provider Agency
957399
AZ
253Z00000X
In Home Supportive Care Agency
957399
AZ
305R00000X
Preferred Provider Organization
957399
AZ
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
957399
AZ
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
957399
AZ
343900000X
Non-emergency Medical Transport (VAN)
957399
AZ
385H00000X
Respite Care
957399
AZ
385HR2050X
Respite Care Camp
957399
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
957399
—
AZ
Enumeration date
02/10/2015
Last updated
02/10/2015
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