Healthcare Provider Details

I. General information

NPI: 1831567940
Provider Name (Legal Business Name): SOBER FLOW RECOVERY PROJECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10315 WOODLEY AVE STE 229 DEVONWOOD OFFICE PARK
GRANADA HILLS CA
91344-6951
US

IV. Provider business mailing address

10315 WOODLEY AVE STE 229 DEVONWOOD OFFICE PARK
GRANADA HILLS CA
91344-6951
US

V. Phone/Fax

Practice location:
  • Phone: 818-207-0870
  • Fax:
Mailing address:
  • Phone: 818-207-0870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number0662
License Number StateNM

VIII. Authorized Official

Name: JIANDAN JANET PAYZA
Title or Position: CLINICAL DIRECTOR/FOUNDER
Credential: MS, LPC, BC-DMT
Phone: 818-207-0870