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General NPI Number Information
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NPI Number | 1891125563
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Entity Type | Organization
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Legal Business Name | SOTERIA, LLC
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Dates
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Enumeration Date | 11/17/2013
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Last Update Date | 11/17/2013
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Provider Practice Location Address
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Address Line | 301 S CENTER ST STE 130
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City | ARLINGTON
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State | TX
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Zip | 76010-7145
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Country | US
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Telephone | 817-300-1590
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Fax |
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Provider Business Mailing Address
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Address Line | 301 S CENTER ST STE 130
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City | ARLINGTON
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State | TX
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Zip | 76010-7145
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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 | CLINICAL DIRECTOR
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Name | JOE EASTHAM
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Credential |
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Telephone | 817-300-1590
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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 | 3687-3688
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License Number State | TX
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