# LIFESTREAM COMPLETE SENIOR LIVING AT SUN RIDGE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LifeStream at Sun Ridge
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932105962
- **Authorized official:** MR. RONALD ESTES (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (623) 933-3333

## Contact information

- **Practice address:** 12215 W BELL RD, SURPRISE, AZ 85378-9640
- **Practice address phone:** (623) 583-5482
- **Practice address fax:** (623) 583-1465
- **Mailing address:** 12215 W BELL RD, SURPRISE, AZ 85378-9640
- **Mailing address phone:** (623) 583-5482
- **Mailing address fax:** (623) 583-1465

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NCI-406 | AZ | Yes |

## Other

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

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1025242 | MERCY CARE ADVANTAGE | AZ |
| 05 | — | 390922 | — | AZ |
| 01 | — | AZ0402330 | BLUE CROSS BLUE SHIELD | AZ |