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General NPI Number Information
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NPI Number | 1083302822
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Entity Type | Organization
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Legal Business Name | AVERY'S HOUSE LLC
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Dates
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Enumeration Date | 04/28/2023
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 10787 W USTICK RD
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City | BOISE
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State | ID
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Zip | 83713-5104
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Country | US
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Telephone | 203-200-8556
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Fax |
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Provider Business Mailing Address
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Address Line | 11445 E VIA LINDA STE 2-617
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-2655
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Country | US
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Telephone | 602-694-9643
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Fax |
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Authorized Official
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Title or Position | BILING DIRECTOR
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Name | ANDREA STINER
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Credential |
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Telephone | 602-694-9643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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