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AGAVE RESIDENTIAL CARE HOME, LLC
NPI 1376058065
Community Based Residential Treatment Facility, Mental Illness in Laveen, AZ

Active since December 05, 2017
5628 W GLASS LN, LAVEEN, AZ 85339(602) 802-9655 Get Directions Write a Review

NPPES record last updated: January 22, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jan 22, 2026, Aug 28, 2021, Dec 5, 2017 (3 updates tracked since 2017).

About Agave Residential Care Home, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AGAVE RESIDENTIAL CARE HOME, LLC (NPI 1376058065) is a healthcare organization registered as a community based residential treatment facility, mental illness in Laveen, Arizona and active in the NPI registry since December 2017. The organization lists Festus Ubiebor, Cheif Officer, as its authorized official.

NPPES Registry Identity

NPI1376058065
Entity TypeOrganization
Primary Taxonomy320800000X
Legal Business NameAGAVE RESIDENTIAL CARE HOME, LLC
Location Address5628 W GLASS LNLaveen, AZ 85339-2278
Mailing Address5628 W Glass LnLaveen, AZ 85339-2278 · (602) 802-9655
Phone(602) 802-9655
Organization SubpartNo
Authorized OfficialFestus UbieborCheif Officer · (602) 931-7437
Enumeration DateDecember 5, 2017
Last NPPES UpdateJanuary 22, 20263 updates tracked since enumeration
NPPES CertifiedJanuary 22, 2026
✔ NPI 1376058065 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Mental IllnessResidential Treatment Facilities
Taxonomy Code320800000X
License✔ Licensed in AZ · BH301
Definition

A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.

5628 W GLASS LN, Laveen, AZ 85339
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Frequently Asked Questions

What is AGAVE RESIDENTIAL CARE HOME, LLC's NPI number?

The NPI number assigned to this healthcare provider is 1376058065, enumerated as an "organization" on December 05, 2017.

Where is the provider located?

The provider is located at 5628 W GLASS LN LAVEEN, AZ 85339 and the phone number is (602) 802-9655.

What is the provider's specialty?

Community Based Residential Treatment Facility, Mental Illness with taxonomy code 320800000X.