| Soba Mesa Llc | |
|
6262 E Broadway Rd Ste 110 Mesa AZ 85206-6101 | |
| (480) 664-4053 | |
| Not Available |
| Full Name | Soba Mesa Llc |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 6262 E Broadway Rd Ste 110, Mesa, Arizona |
| Authorized Official Name and Position | Audrey Graham (CFO) |
| Authorized Official Contact | 3104575250 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Soba Mesa Llc 6262 E Broadway Rd Ste 110 Mesa AZ 85206-6101 Ph: (480) 664-4053 | Soba Mesa Llc 6262 E Broadway Rd Ste 110 Mesa AZ 85206-6101 Ph: (480) 664-4053 |
| NPI Number | 1144670951 |
|---|---|
| Provider Enumeration Date | 06/13/2016 |
| Last Update Date | 06/03/2025 |
| Certification Date | 06/03/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144670951 | NPI | - | NPPES |
| 03D2084103 | Other | AZ | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | OTC6989 (Arizona) | Primary |
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