Agave Residential Care Home, LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

BH301 Issued in AZ

Legal business name

AGAVE RESIDENTIAL CARE HOME, LLC

Practice address

5628 W Glass LN
Laveen, AZ 85339-2278

Phone

(602) 802-9655

NPI assigned

Dec 5, 2017

Last updated

Jan 22, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Festus Ubiebor

Title

Cheif Officer

Phone

(602) 931-7437

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769040000000",
    "number": "1376058065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5628 W GLASS LN",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853392278",
            "telephone_number": "602-802-9655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5628 W GLASS LN",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853392278",
            "telephone_number": "602-802-9655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGAVE RESIDENTIAL CARE HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-05",
        "last_updated": "2026-01-22",
        "certification_date": "2026-01-22",
        "status": "A",
        "authorized_official_last_name": "UBIEBOR",
        "authorized_official_first_name": "FESTUS",
        "authorized_official_title_or_position": "CHEIF OFFICER",
        "authorized_official_telephone_number": "602-931-7437"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": "BH301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Laveen, AZ
• Providers in Laveen, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.