LIVE WELL ASSISTED LIVING


Address: 6462 S 4th St, Phoenix, AZ 85042-7604
Phone: 6233997824

LIVE WELL ASSISTED LIVING (NPI# 1811527047) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1811527047
Entity Type Organization
Organization Name LIVE WELL ASSISTED LIVING
Practice Address 6462 S 4th St
Phoenix
AZ 85042-7604
Practice Telephone 6233997824
Practice Fax Number 8555385652
Mailing Telephone 6233997824
Enumeration Date 2020-01-15
Last Update Date 2020-01-15
Authorized Official Name DESIRE RUSINGIZWA (PROGRAM DIRECTOR)
Authorized Official Telephone 6238773764
Authorized Official Credential BHT
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities Residential Treatment Facilities

Other Provider/Organization Names

Other Name Type Code
LIVE WELL RESIDENTIAL CARE Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1942848627 Live Well Assisted Living Psychiatric Residential Treatment Facility 4544 N 91st Dr, Phoenix, AZ 85037-2449 2019-12-13
1528586195 Live Well Assisted Living Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 12634 W Estero Ln, Litchfield Park, AZ 85340-5156 2017-09-05
1295175719 Live Well Assisted Living Counselor 12634 W Estero Ln, Litchfield Park, AZ 85340-5156 2013-06-28

Office Location

Street Address 6462 S 4TH ST
City PHOENIX
State AZ
Zip Code 85042-7604

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1174028310 Olufemi A Omodara Pharmacist 7227 S. Central Ave, #1080, Phoenix, AZ 85042 2018-03-29
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Taxonomy Information

Taxonomy Code 320600000X
Grouping Residential Treatment Facilities
Classification Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities

Taxonomy Definition

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently.
Notes: [7/1/2003: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
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Competitor

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City PHOENIX
Zip Code 85042

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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