MEDICARE: AZ SOBER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1871340695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AZ SOBER, LLC

Provider Business Mailing Address
First Line	:	2921 S EUGENE CIR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-1566
Country	:	US
Telephone Number	:	612-505-5494
Fax Number	:

Provider Business Practice Location Address
First Line	:	8116 E VISTA BONITA DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-4281
Country	:	US
Telephone Number	:	612-505-5494
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	WADE AARON MUHLHAUSER
Credential	:
Telephone Number	:	612-505-5494

Provider Enumeration Date	:	04/30/2024
Last Update Date	:	04/30/2024

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Directions to “AZ SOBER, LLC ” Practice Location

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