MEDICARE: AVERY'S HOUSE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1083302822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERY'S HOUSE LLC

Provider Business Mailing Address
First Line	:	11445 E VIA LINDA STE 2-617
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85259-2655
Country	:	US
Telephone Number	:	602-694-9643
Fax Number	:

Provider Business Practice Location Address
First Line	:	10787 W USTICK RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-5104
Country	:	US
Telephone Number	:	203-200-8556
Fax Number	:

Authorized Official
Title or Position	:	BILING DIRECTOR
Name	:	ANDREA STINER
Credential	:
Telephone Number	:	602-694-9643

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	12/11/2025

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Directions to “AVERY'S HOUSE LLC ” Practice Location

Language	Start Address	Practice Location

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