OrganizationActive
Agave Residential Care Home, LLC
NPI 1376058065 · Mental Illness Community Based Residential Treatment Facility · Laveen, AZ
Provider details
- NPI number
- 1376058065
- Entity type
- Organization
- Primary specialty
- Mental Illness Community Based Residential Treatment FacilityResidential Treatment Facilities
- Authorized official
- Festus Ubiebor, Cheif Officer
- License
- BH301 (AZ)
Mailing address
5628 W Glass Ln
Laveen, AZ 85339-2278
Registry dates
- Enumerated
- 2017-12-05
- Last updated
- 2026-01-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.