Provider Demographics
NPI:1679263644
Name:SOBER LYFE TREATMENT, INC
Entity Type:Organization
Organization Name:SOBER LYFE TREATMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:CHAUNCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-650-0883
Mailing Address - Street 1:918 E BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-8542
Mailing Address - Country:US
Mailing Address - Phone:813-392-2203
Mailing Address - Fax:
Practice Address - Street 1:918 E BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-8542
Practice Address - Country:US
Practice Address - Phone:813-392-2203
Practice Address - Fax:866-635-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder