Provider Demographics
NPI:1760097471
Name:FIRST STEP CENTER LLC DBA SOUL SURGERY FIRST STEP CENTER
Entity Type:Organization
Organization Name:FIRST STEP CENTER LLC DBA SOUL SURGERY FIRST STEP CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKESPEARE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:480-477-7899
Mailing Address - Street 1:23222 N CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3737
Mailing Address - Country:US
Mailing Address - Phone:480-477-7899
Mailing Address - Fax:480-477-7894
Practice Address - Street 1:23222 N CHURCH RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3737
Practice Address - Country:US
Practice Address - Phone:480-477-7899
Practice Address - Fax:480-477-7894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH5557OtherBEHAVIORAL HEALTH RESIDENTIAL FACILITY