MEDICARE: FLOWERS ASSISTED LIVING INC.

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
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1952607061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOWERS ASSISTED LIVING INC.

Provider Business Mailing Address
First Line	:	124 LAKE HAVASU AVE N
Second Line	:	102
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5640
Country	:	US
Telephone Number	:	928-505-1361
Fax Number	:	928-453-6388

Provider Business Practice Location Address
First Line	:	3301 OSBORN DR
Second Line	:	101-102
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-8993
Country	:	US
Telephone Number	:	928-846-3221
Fax Number	:	928-453-6388

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. FLORA GUEVARA
Credential	:
Telephone Number	:	928-846-3221

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	09/29/2011

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