Organization
LIFESTREAM COMPLETE SENIOR LIVING INC.
Active
Other names
LifeStream at Cook Health Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD ESTES (CHIEF FINANCIAL OFFICER)
(623) 933-3333
Entity
Organization
Contact information
Practice address
11527 W PEORIA AVE, YOUNGTOWN, AZ 85363-1640
(623) 933-4683
(623) 972-4993
Mailing address
11527 W PEORIA AVE, YOUNGTOWN, AZ 85363-1640
(623) 933-4683
(623) 972-4993
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NCI-382
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0071-0000168
UNITEDHEALTHCARE NURSING HOME PLAN
AZ
01
—
0073850
BLUE CROSS BLUE SHIELD
AZ
01
—
010581
ADVANTAGE BY BRIDGEWAY HEALTH SOLUTIONS
AZ
05
—
040311
—
AZ
01
—
1025871
MERCY CARE ADVANTAGE
AZ
Enumeration date
06/23/2005
Last updated
05/21/2013
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