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General NPI Number Information
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NPI Number | 1801350699
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Entity Type | Organization
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Legal Business Name | SOUTHERN ORACLE, LLC
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 25005 N PUMA CIR
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City | RIO VERDE
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State | AZ
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Zip | 85263-7096
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Country | US
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Telephone | 520-266-0141
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Fax |
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Provider Business Mailing Address
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Address Line | 4401 E CAMINO PRINCIPAL
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City | SIERRA VISTA
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State | AZ
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Zip | 85650-9437
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Country | US
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Telephone | 520-266-0141
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEE ANN FREEMAN
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Credential |
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Telephone | 520-266-0141
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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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