# LIFESTREAM COMPLETE SENIOR LIVING INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LifeStream at Cook Health Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447256466
- **Authorized official:** MR. RONALD ESTES (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (623) 933-3333

## Contact information

- **Practice address:** 11527 W PEORIA AVE, YOUNGTOWN, AZ 85363-1640
- **Practice address phone:** (623) 933-4683
- **Practice address fax:** (623) 972-4993
- **Mailing address:** 11527 W PEORIA AVE, YOUNGTOWN, AZ 85363-1640
- **Mailing address phone:** (623) 933-4683
- **Mailing address fax:** (623) 972-4993

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NCI-382 | AZ | Yes |

## Other

- **Enumeration date:** 06/23/2005
- **Last updated:** 05/21/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0071-0000168 | UNITEDHEALTHCARE NURSING HOME PLAN | AZ |
| 01 | — | 0073850 | BLUE CROSS BLUE SHIELD | AZ |
| 01 | — | 010581 | ADVANTAGE BY BRIDGEWAY HEALTH SOLUTIONS | AZ |
| 05 | — | 040311 | — | AZ |
| 01 | — | 1025871 | MERCY CARE ADVANTAGE | AZ |