LIFEWELL BEHAVIORAL WELLNESS (NPI# 1801976709) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801976709 |
| Entity Type | Organization |
| Organization Name | LIFEWELL BEHAVIORAL WELLNESS |
| Practice Address |
621 W Southern Ave Mesa AZ 85210-5004 |
| Mailing Address |
202 E. Earll Drive Suite 200 Phoenix AZ 85012-2647 |
| Practice Telephone | 6028082800 |
| Practice Fax Number | 6028082799 |
| Mailing Telephone | 6028082800 |
| Mailing Fax Number | 6028082799 |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2016-12-14 |
| Authorized Official Name | THOMAS K MCKELVEY (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 6025995410 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | BH2062 | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 729551 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720330194 | Lifewell Behavioral Wellness | Community/Behavioral Health | 6915 E. Main Street, Mesa, AZ 85207-8201 | 2012-10-10 |
| 1386939247 | Lifewell Behavioral Wellness | Community/Behavioral Health | 262 E. University Drive, Mesa, AZ 85201-5932 | 2011-06-17 |
| 1255547444 | Lifewell Behavioral Wellness | Voluntary or Charitable | 119 W. Highland Avenue, Phoenix, AZ 85013-4707 | 2007-05-15 |
| 1306928932 | Lifewell Behavioral Wellness | Substance Abuse Rehabilitation Facility | 3301 E Pinchot Ave, Phoenix, AZ 85018-6807 | 2006-10-20 |
| 1497837025 | Lifewell Behavioral Wellness | Community Based Residential Treatment Facility, Mental Illness | 619 W Southern Ave, Mesa, AZ 85210-5004 | 2006-10-20 |
| 1154401156 | Lifewell Behavioral Wellness | Community Based Residential Treatment Facility, Mental Illness | 3222 N 37th St, Phoenix, AZ 85018-6304 | 2006-10-16 |
| 1982191284 | Lifewell Behavioral Wellness | Community/Behavioral Health | 2311 W Royal Palm Rd, Phoenix, AZ 85021 | 2018-04-23 |
| 1255716601 | Lifewell Behavioral Wellness | Community/Behavioral Health | 2715 N 3rd St, Phoenix, AZ 85004-1106 | 2015-07-28 |
| 1609251057 | Lifewell Behavioral Wellness | Community/Behavioral Health | 3540 E Baseline Rd, Suite 150, Phoenix, AZ 85042-9630 | 2015-07-28 |
| 1790160141 | Lifewell Behavioral Wellness | Community/Behavioral Health | 4451 E Oak St, Phoenix, AZ 85008-2410 | 2015-07-28 |
| Street Address |
621 W SOUTHERN AVE |
| City | MESA |
| State | AZ |
| Zip Code | 85210-5004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265839286 | Lisa Champagne | Case Manager/Care Coordinator | 621 W Southern Ave, Mesa, AZ 85210-5004 | 2014-11-20 |
| 1164828505 | Jennie Lynn Flohrs | Case Manager/Care Coordinator | 621 W Southern Ave, Mesa, AZ 85210-5004 | 2014-11-12 |
| 1619373289 | Jessica Margaret Acton | Case Manager/Care Coordinator | 621 W Southern Ave, Mesa, AZ 85210-5004 | 2014-11-10 |
| 1013313600 | John Johnson Jr. | Case Manager/Care Coordinator | 621 W Southern Ave, Mesa, AZ 85210-5004 | 2014-11-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497382501 | Mesa Center for Family Medicine | Internal Medicine | 2034 S Alma School Road, Suite #101, Mesa, AZ 85210 | 2020-03-26 |
| 1780177121 | Jessica Cannata | Speech-Language Pathologist | 2150 S Country Club Rd, Suite 20, Mesa, AZ 85210 | 2018-06-11 |
| 1831680305 | Alexandra Katherine Ebong | Nurse Practitioner | 1950 S. Country Club Drive, Ste 102, Mesa, AZ 85210 | 2018-05-21 |
| 1548762719 | Russell D. Meldrum, M.d. Pllc | Orthopaedic Surgery | 855 W. Southern Ave., #1114, Mesa, AZ 85210 | 2018-03-05 |
| 1023510435 | Denise M Bruno-krupp | Counselor | 1830 S. Alma School Rd. Suite 101, Mesa, AZ 85210 | 2018-03-01 |
| 1609374529 | Gene R Lullo | Social Worker | 1830 S Alma School Rd Suite 101, Mesa, AZ 85210 | 2018-01-25 |
| 1295264000 | Ashley P Smith | Naturopath | 601 S Alma School Rd, Apt 101, Mesa, AZ 85210 | 2017-06-06 |
| 1386184059 | Brittany Johnson | Counselor | 1745 S Alma School Rd Ste 230, Mesa, AZ 85210 | 2017-03-01 |
| 1487190880 | Mesa Valley Modern Dentistry, LLP | Dentist | 1712 S, Country Club Drive, Ste 104, Mesa, AZ 85210 | 2017-01-10 |
| 1821544529 | Sandra Coren | Licensed Practical Nurse | 32 S Mcdonald, Tlc, Mesa, AZ 85210 | 2016-09-01 |
| Find all providers in zip 85210 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144835968 | Jfox II LLC | Community Based Residential Treatment Facility, Mental Illness | 5327 E Enrose Cir, Mesa, AZ 85205-5489 | 2020-09-09 |
| 1356987119 | Healthy Minds of Arizona | Community Based Residential Treatment Facility, Mental Illness | 2735 E Main St Ste 1, Mesa, AZ 85213-9269 | 2019-11-26 |
| 1174166136 | Harmony Care, LLC | Community Based Residential Treatment Facility, Mental Illness | 2726 S Los Altos, Mesa, AZ 85202-7326 | 2019-10-22 |
| 1700445657 | The Nile Health Network | Community Based Residential Treatment Facility, Mental Illness | 1367 S Country Club Dr Unit 1011, Mesa, AZ 85210-5155 | 2019-06-12 |
| 1780177535 | Legacy Senior Management LLC | Community Based Residential Treatment Facility, Mental Illness | 152 N 56th St Ste B, Mesa, AZ 85205-8718 | 2018-06-07 |
| 1003344367 | Ptl Behavioral Health, LLC | Community Based Residential Treatment Facility, Mental Illness | 10839 E Sonrisa Ave, Mesa, AZ 85212-5126 | 2017-05-31 |
| 1811322795 | Pavillion | Community Based Residential Treatment Facility, Mental Illness | 963 E 9th Pl, Mesa, AZ 85203-5623 | 2013-09-10 |
| 1114272416 | Arizona Behavioral Care Homes LLC | Community Based Residential Treatment Facility, Mental Illness | 1024 N Ridge Cir, Mesa, AZ 85203-5129 | 2012-07-23 |
| 1992911226 | Marc Community Resources, Inc. | Community Based Residential Treatment Facility, Mental Illness | 6433 E Quartz St, Mesa, AZ 85215-0948 | 2007-05-15 |
| 1215143540 | Marc Community Resources, Inc. | Community Based Residential Treatment Facility, Mental Illness | 2664 E Hermosa Vista Dr, Mesa, AZ 85213-2306 | 2007-05-15 |
| Find all providers in MESA | ||||
Please comment or provide details below to improve the information on LIFEWELL BEHAVIORAL WELLNESS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.