NPIMap

Organization Active NPI

Destiny Sober Living II Carver Ranch

  • Substance Abuse Rehabilitation Facility
  • Laveen, AZ
National Provider Identifier
1265849939
Registry record updated Jul 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
DESTINY SOBER LIVING II CARVER RANCH
Practice address
11629 S 43Rd Ave
Laveen, AZ 85339-3245
Phone
(602) 249-6685
NPI assigned
Jul 15, 2014
Last updated
Jul 15, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Marcus J Lewis
Title
President/Ceo
Phone
(602) 249-6675

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X AZ Primary

Addresses

Primary practice location

11629 S 43Rd Ave
Laveen, AZ 85339-3245

Mailing address

11629 S 43Rd Ave
Laveen, AZ 85339-3245
Phone (602) 249-6675

Other identifiers 1

IdentifierTypeStateIssuer
438-43-1827MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
Family Institute for Health and Recovery6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405382400000",
    "number": "1265849939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11629 S 43RD AVE",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853393245",
            "telephone_number": "602-249-6675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11629 S 43RD AVE",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853393245",
            "telephone_number": "602-249-6685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY SOBER LIVING II CARVER RANCH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-15",
        "last_updated": "2014-07-15",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "602-249-6675",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "438-43-1827",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laveen, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.