1124475975 NPI number — SOBER BEGINNINGS TREATMENT CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124475975 NPI number — SOBER BEGINNINGS TREATMENT CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOBER BEGINNINGS TREATMENT CENTER, LLC
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:
SOBE TREATMENT CENTER
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:
1124475975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6944 COLUMBIA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARGATE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33063-8006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-304-5699
Provider Business Mailing Address Fax Number:
954-372-2069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1145 BANKS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARGATE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33063-6702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-814-7623
Provider Business Practice Location Address Fax Number:
954-372-2069
Provider Enumeration Date:
05/23/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ACOSTA
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
954-304-5699

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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