AGAVE RESIDENTIAL CARE HOME LLC NPI 1376058065

NPI Information

NPI: 1376058065
Provider Name: AGAVE RESIDENTIAL CARE HOME, LLC
Classification: Community Based Residential Treatment Facility, Mental Illness - 320800000X
Entity Type: Organization
Address:
5628 W GLASS LN
LAVEEN, AZ
ZIP 85339
Phone: (602) 802-9655
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AGAVE RESIDENTIAL CARE HOME, LLC is a community based residential treatment facility mental illness in Laveen, AZ. The provider is a home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. AGAVE RESIDENTIAL CARE HOME, LLC NPI is 1376058065. The provider is registered as an organization entity type.

The provider's business location address is:

5628 W GLASS LN
LAVEEN, AZ
ZIP 85339-278
Phone: (602) 802-9655

The provider's authorized official is Amanda Ubiebor .
The authorized official title is Administrator and has the following contact phone number (602) 802-9655.

The enumeration date for this NPI number is 12/5/2017 and was last updated on 8/28/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320800000X	Community Based Residential Treatment Facility, Mental Illness		BH301	ARIZONA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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