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Organization

SOBER LIVING LIFESTYLE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
WELLENGTEN JENKINS (DIRECTOR)
(602) 421-6661
Entity
Organization

Contact information

Practice address
6013 W CLAREMONT ST, GLENDALE, AZ 85301-4407
(602) 421-6661
Mailing address
8751 N 51ST AVE STE 108, GLENDALE, AZ 85302-4943
(602) 421-6661

Taxonomy

Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
251B00000X
Case Management Agency
251S00000X
Community/Behavioral Health Agency
Primary
320800000X
Mental Illness Community Based Residential Treatment Facility

Other

Enumeration date
12/01/2022
Last updated
12/01/2022
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