Healthcare Provider Details

I. General information

NPI: 1669276093
Provider Name (Legal Business Name): HEALTHYHOMES 365 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6302 E QUARTZ ST
MESA AZ
85215-0943
US

IV. Provider business mailing address

1343 N 26TH ST
MESA AZ
85213-4111
US

V. Phone/Fax

Practice location:
  • Phone: 480-862-3643
  • Fax:
Mailing address:
  • Phone: 480-862-3643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TICA MASON
Title or Position: DIRECTOR
Credential:
Phone: 480-862-3643