Healthcare Provider Details

I. General information

NPI: 1104720499
Provider Name (Legal Business Name): JUSTIFIED BEHAVIORAL LIVING LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 E INVERNESS AVE APT 1034
MESA AZ
85206-3865
US

IV. Provider business mailing address

3636 E INVERNESS AVE APT 1034
MESA AZ
85206-3865
US

V. Phone/Fax

Practice location:
  • Phone: 480-415-5376
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: SKYE MYLES
Title or Position: CEO
Credential:
Phone: 480-415-5376