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
6215 E ARBOR AVE, MESA, AZ 85206-6064
(480) 664-4053
Mailing address
6262 E BROADWAY RD STE 110, MESA, AZ 85206-6101
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
IFBH7657
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03D2110429
CLIA
AZ
Enumeration date
07/15/2016
Last updated
06/03/2025
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