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NPI Code Detail

MEDICARE: LIFEWELL BEHAVIORAL WELLNESS

MEDICARE: LIFEWELL BEHAVIORAL WELLNESS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320800000XMental Illness Community Based Residential Treatment FacilityBH2406AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154401156
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFEWELL BEHAVIORAL WELLNESS
Provider Business Mailing Address
First Line : 202 E. EARLL DRIVE
Second Line : SUITE 200
City : PHOENIX
State : AZ
Zip : 85012-2647
Country : US
Telephone Number : 602-808-2800
Fax Number : 602-808-2799
Provider Business Practice Location Address
First Line : 3222 N 37TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-6304
Country : US
Telephone Number : 602-808-2800
Fax Number : 602-808-2799
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : THOMAS K MCKELVEY
Credential :
Telephone Number : 602-599-5410
Provider Enumeration Date : 10/16/2006
Last Update Date : 12/14/2016

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Directions to “LIFEWELL BEHAVIORAL WELLNESS ” Practice Location

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