Provider Demographics
NPI:1922510080
Name:SOBER LIFE RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:SOBER LIFE RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-814-5455
Mailing Address - Street 1:321 NORTHLAKE BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5411
Mailing Address - Country:US
Mailing Address - Phone:561-814-5455
Mailing Address - Fax:561-814-5429
Practice Address - Street 1:321 NORTHLAKE BLVD STE 209
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5411
Practice Address - Country:US
Practice Address - Phone:561-814-5455
Practice Address - Fax:561-814-5429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR0405X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility