Provider Demographics
NPI:1205456084
Name:LIFESTREAM COMPLETE SENIOR LIVING INC
Entity type:Organization
Organization Name:LIFESTREAM COMPLETE SENIOR LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONAD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-933-3333
Mailing Address - Street 1:11555 W PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363-1640
Mailing Address - Country:US
Mailing Address - Phone:623-933-3333
Mailing Address - Fax:
Practice Address - Street 1:11525 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1640
Practice Address - Country:US
Practice Address - Phone:623-933-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESTREAM COMPLETE SENIOR LIVING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility