Provider Demographics
NPI:1528394418
Name:SOBER LIFE INC.
Entity Type:Organization
Organization Name:SOBER LIFE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTRANIK
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHISHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-913-0212
Mailing Address - Street 1:5250 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1252
Mailing Address - Country:US
Mailing Address - Phone:323-913-0212
Mailing Address - Fax:323-913-0219
Practice Address - Street 1:5250 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 218
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1252
Practice Address - Country:US
Practice Address - Phone:323-465-3777
Practice Address - Fax:323-465-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility