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Organization
LIFESTREAM COMPLETE SENIOR LIVING AT SUN RIDGE INC
Active
Organization
LIFESTREAM COMPLETE SENIOR LIVING AT SUN RIDGE INC
Active
Other names
LifeStream at Sun Ridge
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD ESTES (CHIEF FINANCIAL OFFICER)
(623) 933-3333
Entity
Organization
Contact information
Practice address
12215 W BELL RD, SURPRISE, AZ 85378-9640
(623) 583-5482
(623) 583-1465
Mailing address
12215 W BELL RD, SURPRISE, AZ 85378-9640
(623) 583-5482
(623) 583-1465
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NCI-406
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1025242
MERCY CARE ADVANTAGE
AZ
05
—
390922
—
AZ
01
—
AZ0402330
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
06/23/2005
Last updated
05/21/2013
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