Healthcare Provider Details

I. General information

NPI: 1558286765
Provider Name (Legal Business Name): LLC DEEPLY ROOTED FAMILY & LIFE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 W CROWN KING RD
TOLLESON AZ
85353-8639
US

IV. Provider business mailing address

10517 W TORONTO WAY
TOLLESON AZ
85353-5630
US

V. Phone/Fax

Practice location:
  • Phone: 602-677-2206
  • Fax:
Mailing address:
  • Phone: 951-867-1858
  • 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 State
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: STEVE REYNOLD REUPENA
Title or Position: CO-CEO
Credential:
Phone: 951-867-1858