NPIMap

Organization Active NPI

Lifestream Complete Senior Living, Inc.

Doing business as LifeStream at Youngtown Green House 3

  • Skilled Nursing Facility
  • Youngtown, AZ
National Provider Identifier
1770026361
Registry record updated Nov 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LIFESTREAM COMPLETE SENIOR LIVING, INC.
Doing business as
LifeStream at Youngtown Green House 3
Practice address
11521 W. Peoria Avenue
Youngtown, AZ 85363
Phone
(623) 972-2371
Fax
(623) 972-7320
NPI assigned
Nov 30, 2016
Last updated
Nov 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2016

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

Authorized official

Name
Donna Taylor
Title
Executive Vice President/Coo
Phone
(623) 933-3333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

11521 W. Peoria Avenue
Youngtown, AZ 85363

Mailing address

11555 W. Peoria Avenue
Youngtown, AZ 85363
Phone (623) 933-3333

Other names 1

  • LifeStream at Youngtown Green House 3 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cook Health Care6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1480464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480464000000",
    "number": "1770026361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11555 W. PEORIA AVENUE",
            "city": "YOUNGTOWN",
            "state": "AZ",
            "postal_code": "85363",
            "telephone_number": "623-933-3333",
            "fax_number": "623-972-7320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11521 W. PEORIA AVENUE",
            "city": "YOUNGTOWN",
            "state": "AZ",
            "postal_code": "85363",
            "telephone_number": "623-972-2371",
            "fax_number": "623-972-7320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTREAM COMPLETE SENIOR LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-30",
        "last_updated": "2016-11-30",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT/COO",
        "authorized_official_telephone_number": "623-933-3333"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeStream at Youngtown Green House 3",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Youngtown, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; 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.