Provider Demographics
NPI:1730846866
Name:LIVE WELL ASSISTED LIVING LLC
Entity type:Organization
Organization Name:LIVE WELL ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DESIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSINGIZWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-214-9544
Mailing Address - Street 1:12634 W ESTERO LN
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-5156
Mailing Address - Country:US
Mailing Address - Phone:602-214-9544
Mailing Address - Fax:
Practice Address - Street 1:12914 W SIERRA VISTA DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85307-1915
Practice Address - Country:US
Practice Address - Phone:602-214-9544
Practice Address - Fax:855-538-5652
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVE WELL ASSISTED LIVING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness