1639359086 NPI number — SOBRIETY SERVICES, INC.

Table of content: (NPI 1639359086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639359086 NPI number — SOBRIETY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOBRIETY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTHCOAST RECOVERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639359086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31877 DEL OBISPO ST
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
SAN JUAN CAPISTRANO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92675-3233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-273-4200
Provider Business Mailing Address Fax Number:
949-488-0447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31877 DEL OBISPO ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SAN JUAN CAPISTRANO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92675-3233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-273-4200
Provider Business Practice Location Address Fax Number:
949-489-1189
Provider Enumeration Date:
11/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LARKIN
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
949-273-4200

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  30077AP , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 300177AP , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)