Organization
AGAVE RESIDENTIAL CARE HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FESTUS UBIEBOR (CHEIF OFFICER)
(602) 931-7437
Entity
Organization
Contact information
Practice address
5628 W GLASS LN, LAVEEN, AZ 85339-2278
(602) 802-9655
Mailing address
5628 W GLASS LN, LAVEEN, AZ 85339-2278
(602) 802-9655
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
BH301
AZ
Other
Enumeration date
12/05/2017
Last updated
01/22/2026
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