Lifestream Complete Senior Living at Thunderbird Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

ALC-4809 Issued in AZ

Legal business name

LIFESTREAM COMPLETE SENIOR LIVING AT THUNDERBIRD INC

Practice address

13617 N 55TH Ave
Glendale, AZ 85304-4701

Phone

(602) 938-5500

Fax

(602) 843-9530

NPI assigned

Jan 19, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Rod Kemp

Title

Chief Financial Officer

Phone

(623) 933-3333

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• LifeStream at Thunderbird Doing business as

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340928000000",
    "number": "1881674414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13617 N 55TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853044701",
            "telephone_number": "602-938-5500",
            "fax_number": "602-843-9530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13617 N 55TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853044701",
            "telephone_number": "602-938-5500",
            "fax_number": "602-843-9530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTREAM COMPLETE SENIOR LIVING AT THUNDERBIRD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2012-06-29",
        "status": "A",
        "authorized_official_last_name": "KEMP",
        "authorized_official_first_name": "ROD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "623-933-3333",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AZ",
            "license": "ALC-4809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EVC00600003119",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "622854",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "E2103020",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeStream at Thunderbird",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Life Care Centers of America, Inc.
• Life Healing Center
• Lifeful Aging, LLC
• Lifeline Professional Counseling Services, Inc
• Lifes Journey LLC
• Lifetree Counseling, LLC
• Scott E Lightfoot, PA-C
• Lighthouse Counselling and Support, LLC
• Gabrielle Denise Ligon, RBT
• Kierra Ligon

• Assisted Living Facility in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Assisted Living Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; 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.