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DESTINY SOBER LIVING NPI 1780194563


NPI Information

NPI: 1780194563
Provider Name: DESTINY SOBER LIVING
Classification: Psychiatric Residential Treatment Facility - 323P00000X
Entity Type: Organization

CLIA Number: 03D2191671

Address:
24032 W ANTELOPE TRL
BUCKEYE, AZ
ZIP 85326
Phone: (602) 224-9667
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DESTINY SOBER LIVING is a psychiatric residential treatment facility in Buckeye, AZ. The provider is a residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient's surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary DESTINY SOBER LIVING NPI is 1780194563. The provider is registered as an organization entity type.

The provider's business location address is:

24032 W ANTELOPE TRL
BUCKEYE, AZ
ZIP 85326-196
Phone: (602) 224-9667
Fax: (602) 926-0590

The provider's authorized official is Marcus J Lewis .
The authorized official title is Ceo and has the following contact phone number (602) 249-6674.

The CLIA number assigned to this NPI record is 03D2191671 - ancillary testing site in health care center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/5/2017 and was last updated on 10/5/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1323P00000XPsychiatric Residential Treatment FacilityBH5238ARIZONAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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