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General NPI Number Information
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NPI Number | 1649686106
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Entity Type | Organization
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Legal Business Name | SOUTHWEST SOBER LIVING, LLC
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Dates
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Enumeration Date | 07/06/2014
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Last Update Date | 07/06/2014
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Provider Practice Location Address
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Address Line | 330 W LOS ALTOS RD
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City | TUCSON
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State | AZ
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Zip | 85704-5671
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Country | US
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Telephone | 520-799-9505
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Fax | 520-799-9506
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Provider Business Mailing Address
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Address Line | 1500 N 15TH AVE
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City | TUCSON
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State | AZ
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Zip | 85705-6413
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Country | US
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Telephone | 520-799-9505
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Fax | 520-799-9506
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Authorized Official
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Title or Position | MEMBER
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Name | MR. KENNETH STINNETT
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Credential |
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Telephone | 520-799-9505
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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 |
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License Number State |
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