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NPI Code Detail

MEDICARE: SOBER HOMIEZ SERVICES LLC

MEDICARE: SOBER HOMIEZ SERVICES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251K00000XPublic Health or Welfare Agency
2174200000XMeals Provider
3177F00000XLodging Provider
4251E00000XHome Health Agency
5251V00000XVoluntary or Charitable Agency
6251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1548893316
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOBER HOMIEZ SERVICES LLC
Provider Business Mailing Address
First Line : 4566 S PECOS RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-5923
Country : US
Telephone Number : 725-261-4369
Fax Number : 702-898-8530
Provider Business Practice Location Address
First Line : 4566 S PECOS RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-5923
Country : US
Telephone Number : 725-261-4369
Fax Number : 702-898-8530
Authorized Official
Title or Position : OPERATING MANAGER/MEMBER
Name : MR. PAUL R MARINO
Credential :
Telephone Number : 725-261-4369
Provider Enumeration Date : 02/19/2020
Last Update Date : 02/19/2020

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Directions to “SOBER HOMIEZ SERVICES LLC ” Practice Location

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