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Soba Mesa Llc
Substance Abuse Rehabilitation Facility in Mesa, Arizona
NPI 1144670951

Soba Mesa Llc is a Substance Abuse Rehabilitation Facility based in Mesa, AZ. Soba Mesa Llc practices in Mesa, AZ. The NPI Number for Soba Mesa Llc is 1144670951 and holds a License No. OTC6989 (Arizona).

The current practice location address for Soba Mesa Llc is 6262 E Broadway Rd Ste 110, Mesa, AZ and can be reached out via phone at 480-664-4053.

Location: 6262 E Broadway Rd Ste 110, Mesa, AZ, 85206-6101
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1144670951
Provider Name
Soba Mesa Llc
Credential
Provider Entity Type
Organization
Address
6262 E Broadway Rd Ste 110, Mesa, AZ, 85206-6101
Phone Number
480-664-4053
Fax Number
Provider Enumeration Date
06/13/2016
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
03D2084103 01 AZ CLIA
institution
Provider Business Practice Location Address Details
Address
6262 E Broadway Rd Ste 110
City
Mesa
State
Arizona
Zip
85206-6101
Phone Number
480-664-4053
Fax Number
person
Provider Business Mailing Address Details
Address
6262 E Broadway Rd Ste 110
City
Mesa
State
Arizona
Zip
85206-6101
Phone Number
480-664-4053
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Rehabilitation, Substance Use Disorder
Taxonomy
261QR0405X
License No.
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Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Residential Treatment Facilities
Classification
Substance Abuse Rehabilitation Facility
Speciality
-
Taxonomy
324500000X
License No.
OTC6989 (Arizona)
Definition
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.
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