Organization
DESTINY SOBER LIVING II CARVER RANCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARCUS J LEWIS (PRESIDENT/CEO)
(602) 249-6675
Entity
Organization
Contact information
Practice address
11629 S 43RD AVE, LAVEEN, AZ 85339-3245
(602) 249-6685
Mailing address
11629 S 43RD AVE, LAVEEN, AZ 85339-3245
(602) 249-6675
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
438-43-1827
—
AZ
Enumeration date
07/15/2014
Last updated
07/15/2014
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