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General NPI Number Information
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NPI Number | 1851898811
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Entity Type | Organization
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Legal Business Name | SOBER FIRST RECOVERY LLC
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 04/06/2018
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Provider Practice Location Address
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Address Line | 3309 CLAY ST
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4208
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Country | US
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Telephone | 949-574-2510
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Fax |
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Provider Business Mailing Address
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Address Line | 3309 CLAY ST
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4208
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LESLEE MANDERSON
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Credential |
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Telephone | 949-294-9974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | 300027BP
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 300027AP
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License Number State | CA
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