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Organization

ARIZONA LIGHTHOUSE ASSISTED LIVING LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. BENNIE LEE HARGROVE (CEO)
(623) 249-1119
Entity
Organization

Contact information

Practice address
13530 W TUCKEY CT, GLENDALE, AZ 85307-2067
(623) 249-1119
Mailing address
13530 W TUCKEY CT, GLENDALE, AZ 85307-2067
(623) 249-1119

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
251E00000X
Home Health Agency
251G00000X
Community Based Hospice Care Agency
251S00000X
Community/Behavioral Health Agency
3104A0625X
Assisted Living Facility (Mental Illness)
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary

Other

Enumeration date
08/28/2023
Last updated
08/28/2023
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