AGAVE RESIDENTIAL CARE HOME, LLC – NPI #1376058065
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.

Health Care Provider Taxonomy Code for Community Based Residential Treatment Facility, Mental Illness

AGAVE RESIDENTIAL CARE HOME, LLC is a community based residential treatment facility located in LAVEEN VILLAGE, AZ. NPPES has assigned the NPI number 1376058065 to AGAVE RESIDENTIAL CARE HOME, LLC on December 05, 2017. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 320800000X from the Health Care Provider Taxonomy code set, which is classified as Community Based Residential Treatment Facility, Mental Illness.

The NPI profile was last updated on Jan 22, 2026. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for AGAVE RESIDENTIAL CARE HOME, LLC below.

NPI Profile for
AGAVE RESIDENTIAL CARE HOME, LLC

NPI Number
1376058065
Enumeration Date

(more than 8 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
AGAVE RESIDENTIAL CARE HOME, LLC
Primary location
5628 W GLASS LN
LAVEEN VILLAGE, AZ 85339-2278
Phone: (602) 802-9655 Fax:
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
FESTUS UBIEBOR
CHEIF OFFICER
Phone: (602) 931-7437
Updated
Certification Date
Jan 22, 2026

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
320800000X
- Community Based Residential Treatment Facility, Mental Illness (Primary)		 AZ BH301

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.