Agave Residential Care Home, LLC
Organization Active NPI Mental Illness Community Based Residential Treatment Facility · Laveen, AZ
NPI 1376058065 · NPPES record last updated Jan 22, 2026
Key facts
- NPI
- 1376058065
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Illness Community Based Residential Treatment Facility 320800000X
- License
- BH301 (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
- Organization subpart
- No
Authorized official
- Name
- Festus Ubiebor
- Title
- Cheif Officer
- Phone
- (602) 931-7437
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | BH301 | AZ | Yes |
Addresses
Primary practice location
5628 W Glass LN
Laveen, AZ 85339-2278
Mailing address
5628 W Glass LN
Laveen, AZ 85339-2278
Phone (602) 802-9655
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All providers in Laveen, AZ · Mental Illness Community Based Residential Treatment Facility in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.