Lifestream Complete Senior Living at Sun Ridge Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NCI-406 Issued in AZ

Legal business name

LIFESTREAM COMPLETE SENIOR LIVING AT SUN RIDGE INC

Doing business as

LifeStream at Sun Ridge

Practice address

12215 W Bell Rd
Surprise, AZ 85378-9640

Phone

(623) 583-5482

Fax

(623) 583-1465

NPI assigned

Jun 23, 2005

Last updated

May 21, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Ronald Estes

Title

Chief Financial Officer

Phone

(623) 933-3333

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• LifeStream at Sun Ridge Doing business as

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369094400000",
    "number": "1932105962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12215 W BELL RD",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853789640",
            "telephone_number": "623-583-5482",
            "fax_number": "623-583-1465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12215 W BELL RD",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853789640",
            "telephone_number": "623-583-5482",
            "fax_number": "623-583-1465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTREAM COMPLETE SENIOR LIVING AT SUN RIDGE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2013-05-21",
        "status": "A",
        "authorized_official_last_name": "ESTES",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "623-933-3333",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "NCI-406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "AZ0402330",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "390922",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MERCY CARE ADVANTAGE",
            "identifier": "1025242",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeStream at Sun Ridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nickole Marie Lewis
• Paige Leykam, APRN
• Derrick Liberty
• John Henry Martin Lico
• Life Care Premier Services LLC
• Vicky Lee Lightfoot, P.T.A.
• Susanna Lockwood Liljenstolpe, FNP
• Lilycare of Arizona LLC
• Kayleigh Lindsay, LPC
• Amber Danielle Lindsey, APRN

• Skilled Nursing Facility in Surprise, AZ
• Providers in Surprise, AZ by specialty
• Skilled Nursing Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2013; 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.