Organization
ORDINARY LIFESTYLES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN WATERS (OWNER)
(928) 595-2068
Entity
Organization
Contact information
Practice address
401 N LAREDO LN, PAYSON, AZ 85541-4389
(928) 595-2068
(888) 673-2528
Mailing address
401 N LAREDO LN, PAYSON, AZ 85541-4389
(928) 595-2068
(888) 673-2528
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AL4632H
AZ
311ZA0620X
Adult Care Home Facility
AL9118H
AZ
311ZA0620X
Adult Care Home Facility
AL9273H
AZ
311ZA0620X
Adult Care Home Facility
AL9592H
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
854100
AHCCCS ID
AZ
Enumeration date
12/18/2014
Last updated
12/18/2014
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