Healthcare Provider Details

I. General information

NPI: 1588376875
Provider Name (Legal Business Name): FAVORABLE HOUSE OF DOVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 S 54TH LN
PHOENIX AZ
85043-4769
US

IV. Provider business mailing address

3803 S 54TH LN
PHOENIX AZ
85043-4769
US

V. Phone/Fax

Practice location:
  • Phone: 623-980-7212
  • Fax:
Mailing address:
  • Phone: 623-980-7212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY WADE
Title or Position: OWNER
Credential:
Phone: 623-980-7212