Healthcare Provider Details

I. General information

NPI: 1982517330
Provider Name (Legal Business Name): LILAC ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 W BRANHAM LN
PHOENIX AZ
85041-7723
US

IV. Provider business mailing address

13309 W MONTEREY WAY
LITCHFIELD PARK AZ
85340-5914
US

V. Phone/Fax

Practice location:
  • Phone: 818-984-4906
  • Fax:
Mailing address:
  • Phone: 818-984-4906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MARIAH VELSA
Title or Position: OWNER
Credential:
Phone: 818-984-4906