Organization
LIFEWELL BEHAVIORAL WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS K MCKELVEY (CHIEF EXECUTIVE OFFICER)
(602) 599-5410
Entity
Organization
Contact information
Practice address
119 W. HIGHLAND AVENUE, PHOENIX, AZ 85013-4707
(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
251V00000X
Voluntary or Charitable Agency
BH2881
AZ
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH4220
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
960302
—
AZ
Enumeration date
05/15/2007
Last updated
12/14/2016
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