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General NPI Number Information
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NPI Number | 1881674414
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Entity Type | Organization
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Legal Business Name | LIFESTREAM COMPLETE SENIOR LIVING AT THUNDERBIRD INC
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 13617 N 55TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85304-4701
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Country | US
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Telephone | 602-938-5500
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Fax | 602-843-9530
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Provider Business Mailing Address
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Address Line | 13617 N 55TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85304-4701
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Country | US
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Telephone | 602-938-5500
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Fax | 602-843-9530
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. ROD KEMP
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Credential |
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Telephone | 623-933-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ALC-4809
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License Number State | AZ
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