# DESTINY SOBER LIVING

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780194563
- **Authorized official:** MR. MARCUS J LEWIS (CEO)
- **Authorized official phone:** (602) 249-6674

## Contact information

- **Practice address:** 24032 W ANTELOPE TRL, BUCKEYE, AZ 85326-7196
- **Practice address phone:** (602) 224-9667
- **Practice address fax:** (602) 926-0590
- **Mailing address:** 5306 N 17TH AVE, PHOENIX, AZ 85015-3035
- **Mailing address phone:** (602) 249-6674
- **Mailing address fax:** (602) 926-0590

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 323P00000X | Psychiatric Residential Treatment Facility | BH5238 | AZ | Yes |

## Other

- **Enumeration date:** 10/05/2017
- **Last updated:** 10/05/2017