NPIMap

Organization Active NPI

Sanctuary Sober Living LLC

  • Substance Abuse Rehabilitation Facility
  • Phoenix, AZ
National Provider Identifier
1275212870
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
SANCTUARY SOBER LIVING LLC
Practice address
1340 E Desert Cove Ave
Phoenix, AZ 85020-1110
Phone
(602) 612-3816
NPI assigned
Jul 12, 2023
Organization subpart
Yes
Parent organization
46400604As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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

Authorized official

Name
Joseph Landin
Title
Ceo
Phone
(602) 612-3816

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary
Non-emergency Medical Transport (VAN) 343900000X

Addresses

Primary practice location

1340 E Desert Cove Ave
Phoenix, AZ 85020-1110

Mailing address

11645 N Cave Creek Rd
Phoenix, AZ 85020-1300
Phone (602) 612-3816

Other names 1

  • SRC Desert Cove Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2288019Sanctuary Sober Living, LLC1340 E Desert Cove Ave, Phoenix, AZ 85020Certificate of waiverAug 20, 2027

National Provider Directory

National Provider Directory
Tax ID family
Sanctuary Sober Living LLC6 organizations share this tax ID, including this one
Part of
Sanctuary Sober Living LLC

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": "1689120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689120000000",
    "number": "1275212870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11645 N CAVE CREEK RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850201300",
            "telephone_number": "602-612-3816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 E DESERT COVE AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850201110",
            "telephone_number": "602-612-3816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANCTUARY SOBER LIVING LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "46400604",
        "enumeration_date": "2023-07-12",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-06",
        "status": "A",
        "authorized_official_last_name": "LANDIN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-612-3816"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SRC Desert Cove",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.