Healthcare Provider Details

I. General information

NPI: 1649718347
Provider Name (Legal Business Name): ASSISTED LIFESTYLES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4385 E WILD ELK TRL
FLAGSTAFF AZ
86004-7921
US

IV. Provider business mailing address

4385 E WILD ELK TRL
FLAGSTAFF AZ
86004-7921
US

V. Phone/Fax

Practice location:
  • Phone: 928-326-0044
  • Fax:
Mailing address:
  • Phone: 928-326-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateAZ

VIII. Authorized Official

Name: MR. DWIGHT C BOYD
Title or Position: CEO
Credential:
Phone: 928-326-0044