Provider Demographics
| NPI: | 1033897178 |
|---|---|
| Name: | NEST SOBER LIVING LLC |
| Entity type: | Organization |
| Organization Name: | NEST SOBER LIVING LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| 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 | ||
| 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 | ||
| Yes | 251S00000X | Agencies | Community/Behavioral Health | ||
| 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 |
