Healthcare Provider Details

I. General information

NPI: 1083302822
Provider Name (Legal Business Name): AVERY'S HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10787 W USTICK RD
BOISE ID
83713-5104
US

IV. Provider business mailing address

11445 E VIA LINDA STE 2-617
SCOTTSDALE AZ
85259-2655
US

V. Phone/Fax

Practice location:
  • Phone: 203-200-8556
  • Fax:
Mailing address:
  • Phone: 602-694-9643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ANDREA STINER
Title or Position: BILING DIRECTOR
Credential:
Phone: 602-694-9643