Provider Demographics
NPI:1083163067
Name:SOBER COACHES OF CALIFORNIA LLC
Entity Type:Organization
Organization Name:SOBER COACHES OF CALIFORNIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:FAILLE
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, CATC III
Authorized Official - Phone:800-714-4796
Mailing Address - Street 1:5980 DANDRIDGE LN
Mailing Address - Street 2:UNIT 208
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6580
Mailing Address - Country:US
Mailing Address - Phone:800-714-4796
Mailing Address - Fax:800-714-4796
Practice Address - Street 1:5980 DANDRIDGE LN
Practice Address - Street 2:UNIT 208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-6580
Practice Address - Country:US
Practice Address - Phone:800-714-4796
Practice Address - Fax:800-714-4796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-01
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1239753251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management