Provider Demographics
NPI:1275212870
Name:SANCTUARY SOBER LIVING LLC
Entity type:Organization
Organization Name:SANCTUARY SOBER LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-612-3816
Mailing Address - Street 1:11645 N CAVE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-1300
Mailing Address - Country:US
Mailing Address - Phone:602-612-3816
Mailing Address - Fax:
Practice Address - Street 1:1340 E DESERT COVE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-1110
Practice Address - Country:US
Practice Address - Phone:602-612-3816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:46400604
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)