Organization
LIFEWELL BEHAVIORAL WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS K MCKELVEY (CHIEF EXECUTIVE OFFICER)
(602) 599-5410
Entity
Organization
Contact information
Practice address
3222 N 37TH ST, PHOENIX, AZ 85018-6304
(602) 808-2800
(602) 808-2799
Mailing address
202 E. EARLL DRIVE, SUITE 200, PHOENIX, AZ 85012-2647
(602) 808-2800
(602) 808-2799
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH2406
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
056970
—
AZ
Enumeration date
10/16/2006
Last updated
12/14/2016
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