Provider Demographics
NPI:1437385937
Name:SOBA LIVING LLC
Entity Type:Organization
Organization Name:SOBA LIVING LLC
Other - Org Name:MALIBU RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNT EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-457-2730
Mailing Address - Street 1:23440 CIVIC CENTER WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5901
Mailing Address - Country:US
Mailing Address - Phone:866-547-6451
Mailing Address - Fax:310-919-3667
Practice Address - Street 1:22677 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5036
Practice Address - Country:US
Practice Address - Phone:866-547-6451
Practice Address - Fax:310-919-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190664AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility