Provider Demographics
NPI:1992192975
Name:FAMILY FIRST ASSISTED LIVING DBA GOLDEN LIFE
Entity Type:Organization
Organization Name:FAMILY FIRST ASSISTED LIVING DBA GOLDEN LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:CNA, CAREGIVER
Authorized Official - Phone:602-999-7576
Mailing Address - Street 1:4113 W HAYWARD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-5751
Mailing Address - Country:US
Mailing Address - Phone:602-999-7576
Mailing Address - Fax:
Practice Address - Street 1:4113 W HAYWARD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051
Practice Address - Country:US
Practice Address - Phone:602-999-7576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9644H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility