NPIMap

Organization Active NPI

Destiny Sober Living

  • Psychiatric Residential Treatment Facility
  • Buckeye, AZ
National Provider Identifier
1780194563
Registry record updated Oct 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
License
BH5238 Issued in AZ
Legal business name
DESTINY SOBER LIVING
Practice address
24032 W Antelope TRL
Buckeye, AZ 85326-7196
Phone
(602) 224-9667
Fax
(602) 926-0590
NPI assigned
Oct 5, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2017

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

Authorized official

Name
Mr. Marcus J Lewis
Title
Ceo
Phone
(602) 249-6674

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X BH5238 AZ Primary

Addresses

Primary practice location

24032 W Antelope TRL
Buckeye, AZ 85326-7196

Mailing address

5306 N 17TH Ave
Phoenix, AZ 85015-3035
Phone (602) 249-6674

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
03D2191668Destiny Sober Living - Antelope24032 W Antelope Trail, Buckeye, AZ 85326Certificate of waiverAug 30, 2026

National Provider Directory

National Provider Directory
Tax ID family
Destiny Sober Living II Carver Ranch6 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": "1507161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507161600000",
    "number": "1780194563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5306 N 17TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850153035",
            "telephone_number": "602-249-6674",
            "fax_number": "602-926-0590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24032 W ANTELOPE TRL",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853267196",
            "telephone_number": "602-224-9667",
            "fax_number": "602-926-0590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY SOBER LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-05",
        "last_updated": "2017-10-05",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-249-6674",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "AZ",
            "license": "BH5238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buckeye, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2017; 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.