Organization
DESTINY SOBER LIVING
Active
Organization
DESTINY SOBER LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARCUS LEWIS (CEO)
(602) 249-6675
Entity
Organization
Contact information
Practice address
5306 N 17TH AVE, PHOENIX, AZ 85015-3035
(602) 249-6675
(602) 237-7242
Mailing address
11629 S 43RD AVE, LAVEEN, AZ 85339-3245
(602) 249-6675
(602) 237-7242
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
BH-3285
AZ
Other
Enumeration date
07/01/2009
Last updated
07/01/2009
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