Destiny Sober Living

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

BH-3285 Issued in AZ

Legal business name

DESTINY SOBER LIVING

Practice address

5306 N 17TH Ave
Phoenix, AZ 85015-3035

Phone

(602) 249-6675

Fax

(602) 237-7242

NPI assigned

Jul 1, 2009

Last updated

Jul 1, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Marcus Lewis

Title

Ceo

Phone

(602) 249-6675

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1246406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246406400000",
    "number": "1336377050",
    "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",
            "fax_number": "602-237-7242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5306 N 17TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850153035",
            "telephone_number": "602-249-6675",
            "fax_number": "602-237-7242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY SOBER LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-01",
        "last_updated": "2009-07-01",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_title_or_position": "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": "BH-3285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Destiny Facility LLC
• Destiny Hands Home Care LLC
• Destiny Hands Medical Staffing
• Destiny Outpatient Services
• Destiny Sober Living
• Richard Destrade Hernandez Sr., PA
• Derek James Detemple, DO
• Morgan Detering, NMD
• Dru Dethlefs, D.O.
• Daniella Darlene Detjens

• Substance Abuse Rehabilitation Facility in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Substance Abuse Rehabilitation Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2009; 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.