Organization
LIVE WELL ASSISTED LIVING
Active
Other names
LIVE WELL RESIDENTIAL CARE
Organization subpart
No
Provider details
NPI number
Authorized official
DESIRE RUSINGIZWA (PROGRAM DIRECTOR)
(602) 214-9544
Entity
Organization
Contact information
Practice address
12634 W ESTERO LN, LITCHFIELD PARK, AZ 85340-5156
(623) 877-3293
(855) 538-5652
Mailing address
10258 W WINDSOR BLVD, GLENDALE, AZ 85307-4124
(623) 877-3293
(855) 538-5652
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
BH-5157
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
860056
—
AZ
Enumeration date
09/05/2017
Last updated
09/05/2017
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