Healthcare Provider Details

I. General information

NPI: 1033897178
Provider Name (Legal Business Name): NEST SOBER LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5731 S 29TH PL
PHOENIX AZ
85040-3753
US

IV. Provider business mailing address

5731 S 29TH PL
PHOENIX AZ
85040-3753
US

V. Phone/Fax

Practice location:
  • Phone: 480-204-5225
  • Fax:
Mailing address:
  • Phone: 480-204-5225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA RUIZ
Title or Position: DIRECTOR
Credential:
Phone: 480-798-6459