Healthcare Provider Details

I. General information

NPI: 1558772442
Provider Name (Legal Business Name): SOBA CHEVIOT HILLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3384 MOTOR AVE
LOS ANGELES CA
90034-3712
US

IV. Provider business mailing address

3384 MOTOR AVE
LOS ANGELES CA
90034-3712
US

V. Phone/Fax

Practice location:
  • Phone: 310-457-2730
  • Fax: 310-919-0319
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number190822AP
License Number StateCA

VIII. Authorized Official

Name: MICHELLE JOHNS
Title or Position: ACCOUNT EXECUTIVE
Credential:
Phone: 310-457-2730