Organization
NEXT LEVEL VITALITY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIA ROSS (OWNER)
(619) 366-1546
Entity
Organization
Contact information
Practice address
26 W BRAHMAN BLVD, SAN TAN VALLEY, AZ 85143-4852
(619) 366-1546
Mailing address
26 W BRAHMAN BLVD, SAN TAN VALLEY, AZ 85143-4852
(619) 366-1546
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
08/15/2019
Last updated
09/22/2022
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