Organization
SOBA MESA LLC
Active
Organization
SOBA MESA LLC
Active
Other names
Soba Recovery Center
Organization subpart
No
Provider details
NPI number
Authorized official
AUDREY GRAHAM (CFO)
(310) 457-5250
Entity
Organization
Contact information
Practice address
6262 E BROADWAY RD STE 110, MESA, AZ 85206-6101
(480) 664-4053
Mailing address
6262 E BROADWAY RD STE 110, MESA, AZ 85206-6101
(480) 664-4053
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
OTC6989
AZ
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03D2084103
CLIA
AZ
Enumeration date
06/13/2016
Last updated
06/09/2026
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