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Lifewell Behavioral Wellness

Organization Active NPI Mental Illness Community Based Residential Treatment Facility · Mesa, AZ

NPI 1801976709 · NPPES record last updated Dec 14, 2016

Key facts

NPI
1801976709
Entity type
Organization (NPI type 2)
Primary specialty
Mental Illness Community Based Residential Treatment Facility 320800000X
License
BH2062
Legal business name
LIFEWELL BEHAVIORAL WELLNESS
Practice address
621 W Southern Ave
Mesa, AZ 85210-5004
Phone
(602) 808-2800
Fax
(602) 808-2799
NPI assigned
Oct 16, 2006
Organization subpart
No

Authorized official

Name
Thomas K McKelvey
Title
Chief Executive Officer
Phone
(602) 599-5410

Corporate family (same tax ID) 18

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

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
Lifewell (19 organizations share this tax ID)

Locations

621 W Southern Ave
Mesa, AZ 85210
Phone (602) 329-3494

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X BH2062 Yes

Addresses

Primary practice location

621 W Southern Ave
Mesa, AZ 85210-5004

Mailing address

202 E. Earll Drive
Suite 200
Phoenix, AZ 85012-2647
Phone (602) 808-2800

Other identifiers

IdentifierTypeStateIssuer
729551MedicaidAZ

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 14, 2016.

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481673600000",
    "number": "1801976709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E. EARLL DRIVE",
            "address_2": "SUITE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122647",
            "telephone_number": "602-808-2800",
            "fax_number": "602-808-2799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 W SOUTHERN AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852105004",
            "telephone_number": "602-808-2800",
            "fax_number": "602-808-2799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEWELL BEHAVIORAL WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2016-12-14",
        "status": "A",
        "authorized_official_last_name": "MCKELVEY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "602-599-5410"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": "BH2062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "729551",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

All providers in Mesa, AZ · Mental Illness Community Based Residential Treatment Facility in Arizona

Sources for this page

Verify at the official NPI Registry.