Provider Demographics
NPI:1770020133
Name:YOUNG LIFE ASSISTED LIVING INC.
Entity Type:Organization
Organization Name:YOUNG LIFE ASSISTED LIVING INC.
Other - Org Name:YOUNG LIFE AL 5
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:IONUT
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-561-1285
Mailing Address - Street 1:1518 W ORANGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7950
Mailing Address - Country:US
Mailing Address - Phone:602-561-1285
Mailing Address - Fax:
Practice Address - Street 1:5826 N 27TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-2637
Practice Address - Country:US
Practice Address - Phone:602-595-0131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL10210H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility