Provider Demographics
NPI:1568792372
Name:FLOWER'S ASSISTED LIVING, INC
Entity Type:Organization
Organization Name:FLOWER'S ASSISTED LIVING, INC
Other - Org Name:DBA FLOWERS CAREGIVER SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-846-3221
Mailing Address - Street 1:P.O. BOX 991
Mailing Address - Street 2:124 N. LAKE HAVASU AVENUE 102
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86405
Mailing Address - Country:US
Mailing Address - Phone:928-846-3221
Mailing Address - Fax:928-453-6388
Practice Address - Street 1:124 LAKE HAVASU AVENUE N 102
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403
Practice Address - Country:US
Practice Address - Phone:928-846-3221
Practice Address - Fax:928-453-6388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLOWERS ASSISTED LIVING, INC. DBA FLOWERS CAREGIVER SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-30
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ477350251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ477350OtherARIZONA HEALTH CARE COST CONTAINMENT SYSTEM