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General NPI Number Information
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NPI Number | 1558286765
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Entity Type | Organization
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Legal Business Name | LLC DEEPLY ROOTED FAMILY & LIFE SERVICES
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 9025 W CROWN KING RD
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City | TOLLESON
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State | AZ
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Zip | 85353-8639
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Country | US
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Telephone | 602-677-2206
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Fax |
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Provider Business Mailing Address
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Address Line | 10517 W TORONTO WAY
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City | TOLLESON
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State | AZ
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Zip | 85353-5630
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Country | US
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Telephone | 951-867-1858
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Fax |
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Authorized Official
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Title or Position | CO-CEO
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Name | STEVE REYNOLD REUPENA
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Credential |
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Telephone | 951-867-1858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based 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 | 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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