Organization
SOBA TEXAS LLC
Active
Other names
Soba Recovery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AUDREY GRAHAM (CFO)
(310) 457-5250
Entity
Organization
Contact information
Practice address
1401 DEZARAE LOT 3, SAN ANTONIO, TX 78253-5986
(210) 530-4167
(310) 919-0319
Mailing address
1401 DEZARAE LOT 3, SAN ANTONIO, TX 78253-5986
(310) 457-2730
(310) 919-0319
Taxonomy
Speciality
Code
Description
License number
State
2084P0802X
Addiction Psychiatry Physician
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D2067229
CMS CLIA
TX
Enumeration date
12/10/2013
Last updated
09/16/2025
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