Provider Demographics
NPI:1629421037
Name:SOBER SPOT LLC, THE
Entity Type:Organization
Organization Name:SOBER SPOT LLC, THE
Other - Org Name:THE SOBER SPOT RECOVERY CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAGUL
Authorized Official - Suffix:
Authorized Official - Credentials:PROGRM DIRECTOR
Authorized Official - Phone:718-614-8044
Mailing Address - Street 1:25241 PASEO DE ALICIA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4643
Mailing Address - Country:US
Mailing Address - Phone:949-388-5123
Mailing Address - Fax:888-510-9071
Practice Address - Street 1:25241 PASEO DE ALICIA
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4643
Practice Address - Country:US
Practice Address - Phone:949-388-5123
Practice Address - Fax:888-510-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300333AP261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300333APOtherSTATE OF CALIFORNIA LICENSE