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General NPI Number Information
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NPI Number | 1932105962
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Entity Type | Organization
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Legal Business Name | LIFESTREAM COMPLETE SENIOR LIVING AT SUN RIDGE INC
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 05/21/2013
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Provider Practice Location Address
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Address Line | 12215 W BELL RD
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City | SURPRISE
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State | AZ
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Zip | 85378-9640
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Country | US
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Telephone | 623-583-5482
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Fax | 623-583-1465
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Provider Business Mailing Address
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Address Line | 12215 W BELL RD
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City | SURPRISE
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State | AZ
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Zip | 85378-9640
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Country | US
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Telephone | 623-583-5482
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Fax | 623-583-1465
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. RONALD ESTES
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NCI-406
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License Number State | AZ
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