Agave Residential Care Home, LLC
Community Based Residential Treatment Facility, Mental Illness in Laveen, AZ. Organization (NPI-2).
Details
- NPI
- 1376058065
- Entity type
- Organization (NPI-2)
- Legal business name
- Agave Residential Care Home, LLC
- Organization subpart
- No
- Enumeration date
- Dec 5, 2017
- Certification date
- Jan 22, 2026
- Last updated
- Jan 22, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | BH301 | AZ | Yes |
Practice location
5628 W Glass LnLaveen, AZ 85339-2278
Phone 602-802-9655
Mailing address
5628 W Glass LnLaveen, AZ 85339-2278
Phone 602-802-9655
Authorized official
Festus Ubiebor
Cheif Officer
6029317437
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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