NPIMap

Organization Active NPI

Az Sober Living & Behavioral Health Group, LLC

  • Psychiatry Physician
  • Phoenix, AZ
National Provider Identifier
1538683081
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
AZ SOBER LIVING & BEHAVIORAL HEALTH GROUP, LLC
Practice address
2920 N 24TH Ave Ste 120
Phoenix, AZ 85015-5958
Phone
(623) 302-9213
NPI assigned
Jul 26, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Waldeck Charles, MDNPI 1689752123
Title
Medical Director
Phone
(602) 315-7033

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

2920 N 24TH Ave Ste 120
Phoenix, AZ 85015-5958

Mailing address

2920 N 24TH Ave Ste 150
Phoenix, AZ 85015-5959
Phone (623) 302-9213

National Provider Directory

National Provider Directory

Locations

2920 N 24th Ave
Ste 120
Phoenix, AZ 85015
Phone (623) 302-9213

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1501027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1538683081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 N 24TH AVE STE 150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850155959",
            "telephone_number": "623-302-9213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 N 24TH AVE STE 120",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850155958",
            "telephone_number": "623-302-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZ SOBER LIVING & BEHAVIORAL HEALTH GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-26",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "WALDECK",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "602-315-7033",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 21, 2022; 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.