=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538706775
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOBERMAN'S ESTATE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2019
-----------------------------------------------------
Last Update Date | 03/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3010 E CLOUD RD
-----------------------------------------------------
City | CAVE CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85331-5621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-295-8013
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 EASY ST UNIT 5167
-----------------------------------------------------
City | CAREFREE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85377-7116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-295-8013
-----------------------------------------------------
Fax | 833-969-0106
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MITCH PRAGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 602-295-8013
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------