SOBA MESA LLC NPI 1144670951

NPI Information

NPI: 1144670951
Provider Name: SOBA MESA LLC

Doing Business As: SOBA RECOVERY CENTER

Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization

CLIA Number: 03D2084103

Address:
6262 E BROADWAY RD STE 110
MESA, AZ
ZIP 85206
Phone: (480) 664-4053
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SOBA MESA LLC is a substance abuse rehabilitation facility in Mesa, AZ. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. SOBA MESA LLC NPI is 1144670951. The provider is registered as an organization entity type.
The provider Is Doing Business As Soba Recovery Center.

The provider's business location address is:

6262 E BROADWAY RD STE 110
MESA, AZ
ZIP 85206-101
Phone: (480) 664-4053

The provider's authorized official is Audrey Graham .
The authorized official title is Cfo and has the following contact phone number (310) 457-5250.

The CLIA number assigned to this NPI record is 03D2084103 - other - treatment facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/13/2016 and was last updated on 2/1/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	OTC6989	ARIZONA	No
2	324500000X	Substance Abuse Rehabilitation Facility				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	03D2084103	OTHER	ARIZONA	CLIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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