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General NPI Number Information
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NPI Number | 1528200961
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Entity Type | Organization
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Legal Business Name | SOBER SHORES, INCORPORATED
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 03/31/2009
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Provider Practice Location Address
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Address Line | 42509 CARINO PL
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City | TEMECULA
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State | CA
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Zip | 92592-2239
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Country | US
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Telephone | 866-660-5763
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Fax | 951-526-2264
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Provider Business Mailing Address
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Address Line | 42509 CARINO PL
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City | TEMECULA
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State | CA
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Zip | 92592-2239
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Country | US
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Telephone | 866-660-5763
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Fax | 951-526-2264
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. SEAN REAGAN STAFFORD SR.
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Credential | J.D., CAS
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Telephone | 866-660-5763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 330084AP
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License Number State | CA
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