NPIMap

Organization Active NPI

Sanctuary Sober Living LLC

Doing business as SRC Rose Garden

  • Substance Abuse Rehabilitation Facility
  • Phoenix, AZ
National Provider Identifier
1285346049
Registry record updated Dec 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
SANCTUARY SOBER LIVING LLC
Doing business as
SRC Rose Garden
Practice address
2027 E Rose Garden LN
Phoenix, AZ 85024-4418
Phone
(602) 612-3816
Fax
(602) 612-3769
NPI assigned
Dec 22, 2022
Organization subpart
Yes
Parent organization
SANCTUARY SOBER LIVING LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 22, 2022

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

Authorized official

Name
Joseph Landin
Title
Ceo
Phone
(480) 309-9945

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Psychiatric Residential Treatment Facility 323P00000X
Substance Abuse Rehabilitation Facility 324500000X Primary
Non-emergency Medical Transport (VAN) 343900000X

Addresses

Primary practice location

2027 E Rose Garden LN
Phoenix, AZ 85024-4418

Mailing address

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

Other names 1

  • SRC Rose Garden 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
03D2288021Sanctuary Sober Living, LLC2027 E Rose Garden Lane, Phoenix, AZ 85024Certificate 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.

Locations

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1671667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671667200000",
    "number": "1285346049",
    "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": "2027 E ROSE GARDEN LN",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850244418",
            "telephone_number": "602-612-3816",
            "fax_number": "602-612-3769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANCTUARY SOBER LIVING LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANCTUARY SOBER LIVING LLC",
        "enumeration_date": "2022-12-22",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A",
        "authorized_official_last_name": "LANDIN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-309-9945"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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 Rose Garden",
            "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 Dec 22, 2022; 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.