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General NPI Number Information
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NPI Number | 1285346049
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Entity Type | Organization
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Legal Business Name | SANCTUARY SOBER LIVING LLC
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Dates
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Enumeration Date | 12/22/2022
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 2027 E ROSE GARDEN LN
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City | PHOENIX
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State | AZ
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Zip | 85024-4418
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Country | US
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Telephone | 602-612-3816
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Fax | 602-612-3769
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Provider Business Mailing Address
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Address Line | 11645 N CAVE CREEK RD
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City | PHOENIX
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State | AZ
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Zip | 85020-1300
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Country | US
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Telephone | 602-612-3816
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOSEPH LANDIN
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Credential |
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Telephone | 480-309-9945
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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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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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