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Organization
LIVE WELL ASSISTED LIVING
Active
Organization
LIVE WELL ASSISTED LIVING
Active
Other names
LIVE WELL RESIDENTIAL CARE
Organization subpart
No
Provider details
NPI number
Authorized official
DESIRE RUSINGIZWA (PROGRAM DIRECTOR)
(602) 214-9544
Entity
Organization
Contact information
Practice address
12634 W ESTERO LN, LITCHFIELD PARK, AZ 85340-5156
(623) 877-3293
(855) 538-5652
Mailing address
10258 W WINDSOR BLVD, GLENDALE, AZ 85307-4124
(623) 877-3293
(855) 538-5652
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
BH-5157
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
860056
—
AZ
Enumeration date
09/05/2017
Last updated
09/05/2017
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