Provider Demographics
NPI:1306437553
Name:LAVEEN SUNSETS RESIDENTIAL HOMES LLC
Entity type:Organization
Organization Name:LAVEEN SUNSETS RESIDENTIAL HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:UWIMANA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:602-399-0314
Mailing Address - Street 1:3001 W DONNER DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041
Mailing Address - Country:US
Mailing Address - Phone:602-399-0134
Mailing Address - Fax:
Practice Address - Street 1:3001 W DONNER DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041
Practice Address - Country:US
Practice Address - Phone:602-399-0134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-31
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities