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
3301 E PINCHOT AVE, PHOENIX, AZ 85018-6807
(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
324500000X
Substance Abuse Rehabilitation Facility
Primary
BH165
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
056962
—
AZ
Enumeration date
10/20/2006
Last updated
11/03/2016
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