# HEALTHY LIFESTYLE RESIDENCE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780903872
- **Authorized official:** MS. FELICISIMA A. GRAHAM RFA (ADMINISTRATOR)
- **Authorized official phone:** (775) 828-5151

## Contact information

- **Practice address:** 3990 LAKESIDE DR, RENO, NV 89509-5336
- **Practice address phone:** (775) 828-5151
- **Practice address fax:** (775) 828-5152
- **Mailing address:** 3990 LAKESIDE DR, RENO, NV 89509-5336
- **Mailing address phone:** (775) 828-5151
- **Mailing address fax:** (775) 828-5152

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | 5880AGC-0 | NV | Yes |

## Other

- **Enumeration date:** 05/27/2010
- **Last updated:** 05/27/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 9005055957 | ATYPICAL PROVIDER IDENTIFIER NEVADA DIVISION OF HEALTHCARE FINANCING AND POLICY | NV |