Provider Demographics
NPI:1770393423
Name:SOTERIA BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:SOTERIA BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:MYLES
Authorized Official - Last Name:CARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:910-691-8188
Mailing Address - Street 1:330 E 700 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4170
Mailing Address - Country:US
Mailing Address - Phone:910-691-8188
Mailing Address - Fax:888-293-8686
Practice Address - Street 1:959 N LA BREA AVE FL 2
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-2207
Practice Address - Country:US
Practice Address - Phone:310-672-6200
Practice Address - Fax:888-293-8686
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOTERIA HOME HEALTH AGENCY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health