NPIMap

Organization Active NPI

Live Well Assisted Living

Doing business as Live Well Residential Care

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Litchfield Park, AZ
National Provider Identifier
1528586195
Registry record updated Sep 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
BH-5157 Issued in AZ
Legal business name
LIVE WELL ASSISTED LIVING
Doing business as
Live Well Residential Care
Practice address
12634 W Estero LN
Litchfield Park, AZ 85340-5156
Phone
(623) 877-3293
Fax
(855) 538-5652
NPI assigned
Sep 5, 2017
Last updated
Sep 5, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2017

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

Authorized official

Name
Desire Rusingizwa
Title
Program Director
Phone
(602) 214-9544

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X BH-5157 AZ Primary

Addresses

Primary practice location

12634 W Estero LN
Litchfield Park, AZ 85340-5156

Mailing address

10258 W Windsor Blvd
Glendale, AZ 85307-4124
Phone (623) 877-3293

Other identifiers 1

IdentifierTypeStateIssuer
860056MedicaidAZ

Other names 1

  • LIVE WELL RESIDENTIAL CARE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Live Well Assisted Living LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1504569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504569600000",
    "number": "1528586195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10258 W WINDSOR BLVD",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853074124",
            "telephone_number": "623-877-3293",
            "fax_number": "855-538-5652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12634 W ESTERO LN",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "853405156",
            "telephone_number": "623-877-3293",
            "fax_number": "855-538-5652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE WELL ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-05",
        "last_updated": "2017-09-05",
        "status": "A",
        "authorized_official_last_name": "RUSINGIZWA",
        "authorized_official_first_name": "DESIRE",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "602-214-9544"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "AZ",
            "license": "BH-5157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "860056",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIVE WELL RESIDENTIAL CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Litchfield Park, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2017; 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.