| NPI | 1558772442 |
|---|---|
| Doing Business As | CLUB SOBA |
| Entity Type | Organization |
| Authorized Contact | MICHELLE JOHNS Account Executive 310-457-2730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: CA 190822AP) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2016-07-29 |