Provider Demographics
NPI: | 1033897178 |
---|---|
Name: | NEST SOBER LIVING LLC |
Entity Type: | Organization |
Organization Name: | NEST SOBER LIVING LLC |
Other - Org Name: | NEST RECOVERY COMMUNITY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PATRICIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RUIZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 480-798-6459 |
Mailing Address - Street 1: | 5731 S 29TH PL |
Mailing Address - Street 2: | |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85040-3753 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-204-5225 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5731 S 29TH PL |
Practice Address - Street 2: | |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85040-3753 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-204-5225 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | NEST SOBER LIVING LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2023-07-10 |
Last Update Date: | 2023-08-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | ||
Yes | 251S00000X | Agencies | Community/Behavioral Health | ||
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | ||
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program | Group - Multi-Specialty | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
No | 174200000X | Other Service Providers | Meals | ||
No | 1744G0900X | Other Service Providers | Specialist | Graphics Designer | Group - Multi-Specialty |
No | 177F00000X | Other Service Providers | Lodging | ||
No | 246Y00000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Health Information | Group - Multi-Specialty | |
No | 246Z00000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Group - Multi-Specialty | |
No | 251B00000X | Agencies | Case Management | ||
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |