Provider Demographics
NPI:1225860604
Name:ORDINARY LIFESTYLES, LLC
Entity type:Organization
Organization Name:ORDINARY LIFESTYLES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-595-2068
Mailing Address - Street 1:401 N LAREDO LN
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4389
Mailing Address - Country:US
Mailing Address - Phone:928-595-2068
Mailing Address - Fax:
Practice Address - Street 1:718 N FOX HILL CIR
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-6620
Practice Address - Country:US
Practice Address - Phone:928-595-2068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORDINARY LIFESTYLES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home