Healthcare Provider Details

I. General information

NPI: 1548893316
Provider Name (Legal Business Name): SOBER HOMIEZ SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4566 S PECOS RD
LAS VEGAS NV
89121-5923
US

IV. Provider business mailing address

4566 S PECOS RD
LAS VEGAS NV
89121-5923
US

V. Phone/Fax

Practice location:
  • Phone: 725-261-4369
  • Fax: 702-898-8530
Mailing address:
  • Phone: 725-261-4369
  • Fax: 702-898-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL R MARINO
Title or Position: OPERATING MANAGER/MEMBER
Credential:
Phone: 725-261-4369