Organization
SOUL PURPOSE SOBER LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT DITOMASO (OWNER)
(702) 488-4918
Entity
Organization
Contact information
Practice address
3667 EL CAMINO RD, LAS VEGAS, NV 89103-1102
(702) 488-4918
Mailing address
3667 EL CAMINO RD, LAS VEGAS, NV 89103-1102
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NV20171125758
BUSINESS LICENSE
—
Enumeration date
01/25/2019
Last updated
02/07/2019
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