Healthcare Provider Details

I. General information

NPI: 1205524329
Provider Name (Legal Business Name): HOREBU COMMUNITY SOBER LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W SUNNYSIDE AVE
PHOENIX AZ
85029-3535
US

IV. Provider business mailing address

2001 W SUNNYSIDE AVE
PHOENIX AZ
85029-3535
US

V. Phone/Fax

Practice location:
  • Phone: 480-501-0957
  • Fax:
Mailing address:
  • Phone: 480-501-0957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric 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: YVONNE BAHATI
Title or Position: DIRECTRESS
Credential:
Phone: 480-501-0957