Provider Demographics
NPI:1457068686
Name:SOZO RECOVERY LLC
Entity Type:Organization
Organization Name:SOZO RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, NP
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:BONSALL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:318-801-0425
Mailing Address - Street 1:108 HARVEST OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-4001
Mailing Address - Country:US
Mailing Address - Phone:318-801-0425
Mailing Address - Fax:
Practice Address - Street 1:2601 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5160
Practice Address - Country:US
Practice Address - Phone:318-801-0425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty