# LIFESTREAM COMPLETE SENIOR LIVING AT NORTHEAST PHOENIX, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LifeStream at Northeast Phoenix Green House 84
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144763731
- **Authorized official:** DONNA TAYLOR (EXECUTIVE VICE PRESIDENT/COO)
- **Authorized official phone:** (623) 933-3333

## Contact information

- **Practice address:** 20802 N. CAVE CREEK ROAD, BUILDING 84, PHOENIX, AZ 85024
- **Practice address phone:** (602) 569-0508
- **Practice address fax:** (602) 569-0301
- **Mailing address:** 11555 W. PEORIA AVENUE, YOUNGTOWN, AZ 85363
- **Mailing address phone:** (623) 933-3333
- **Mailing address fax:** (623) 972-7320

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/30/2016
- **Last updated:** 11/30/2016