Organization
DESTINY SOBER LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARCUS J LEWIS (CEO)
(602) 249-6674
Entity
Organization
Contact information
Practice address
24032 W ANTELOPE TRL, BUCKEYE, AZ 85326-7196
(602) 224-9667
(602) 926-0590
Mailing address
5306 N 17TH AVE, PHOENIX, AZ 85015-3035
(602) 249-6674
(602) 926-0590
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
BH5238
AZ
Other
Enumeration date
10/05/2017
Last updated
10/05/2017
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