Organization Name: | LIVE WELL ASSISTED LIVING |
NPI Number: | 1295175719 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DESIRE RUSINGIZWA (PROGRAM DIRECTOR) |
Mailing Address: | 12634 W Estero Ln Litchfield Park |
State: | AZ US |
Postal Code: | 853405156 |
Phone Number: | 6022149544 |
Fax Number: | 6232664688 |
NPI Enumeration Date: | 06/28/2013 |
NPI Last Update Date: | 06/28/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |