SOBA MESA LLC NPI 1144670951

NPI Information

  • NPI: 1144670951
  • Provider Name: SOBA MESA LLC
  • Classification: Clinic/Center - 261QR0405X
  • Specialization: Rehabilitation, Substance Use Disorder
  • 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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NPI Details

SOBA MESA LLC is a rehabilitation and substance use disorder clinic center in Mesa, AZ. SOBA MESA LLC NPI is 1144670951. The provider is registered as an organization entity type.
The provider .

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 6/3/2025.

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
1261QM0850XClinic/CenterAdult Mental HealthNo
2261QR0405XClinic/CenterRehabilitation, Substance Use DisorderOTC6989ARIZONAYes

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
103D2084103OTHERARIZONACLIA

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: 11/21/2025

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