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General NPI Number Information
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NPI Number | 1679263644
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Entity Type | Organization
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Legal Business Name | SOBER LYFE TREATMENT, INC
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 09/23/2023
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Provider Practice Location Address
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Address Line | 918 E BUSCH BLVD
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City | TAMPA
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State | FL
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Zip | 33612-8542
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Country | US
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Telephone | 813-392-2203
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Fax | 866-635-1288
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Provider Business Mailing Address
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Address Line | 918 E BUSCH BLVD
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City | TAMPA
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State | FL
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Zip | 33612-8542
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Country | US
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Telephone | 813-392-2203
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES GREGORY CHAUNCEY
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Credential |
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Telephone | 352-650-0883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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