Provider Demographics
NPI:1649686106
Name:SOUTHWEST SOBER LIVING, LLC
Entity type:Organization
Organization Name:SOUTHWEST SOBER LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:STINNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-799-9505
Mailing Address - Street 1:1500 N 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-6413
Mailing Address - Country:US
Mailing Address - Phone:520-799-9505
Mailing Address - Fax:520-799-9506
Practice Address - Street 1:330 W LOS ALTOS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5671
Practice Address - Country:US
Practice Address - Phone:520-799-9505
Practice Address - Fax:520-799-9506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-06
Last Update Date:2014-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility