Provider Demographics
NPI:1669163937
Name:SOTERIA WELLNESS CENTER LLC
Entity type:Organization
Organization Name:SOTERIA WELLNESS CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKENYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-287-9324
Mailing Address - Street 1:31048 N RANCHO TIERRA DR
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5909
Mailing Address - Country:US
Mailing Address - Phone:508-904-2782
Mailing Address - Fax:
Practice Address - Street 1:31048 N RANCHO TIERRA DR
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5909
Practice Address - Country:US
Practice Address - Phone:508-904-2782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health