Provider Demographics
NPI:1851898811
Name:SOBER FIRST RECOVERY LLC
Entity Type:Organization
Organization Name:SOBER FIRST RECOVERY LLC
Other - Org Name:SOBER FIRST RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-294-9974
Mailing Address - Street 1:3309 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3309 CLAY ST
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4208
Practice Address - Country:US
Practice Address - Phone:949-574-2510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300027BP261QR0401X
CA300027AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)