Healthcare Provider Details

I. General information

NPI: 1922510080
Provider Name (Legal Business Name): SOBER LIFE RECOVERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2017
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 NORTHLAKE BLVD STE 209
NORTH PALM BEACH FL
33408-5411
US

IV. Provider business mailing address

321 NORTHLAKE BLVD STE 209
NORTH PALM BEACH FL
33408-5411
US

V. Phone/Fax

Practice location:
  • Phone: 561-814-5455
  • Fax: 561-814-5429
Mailing address:
  • Phone: 561-814-5455
  • Fax: 561-814-5429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JARED ANDIA
Title or Position: OWNER
Credential:
Phone: 561-814-5455