Provider Demographics
NPI:1083371769
Name:SOLUTIONS OF SOBRIETY LLC
Entity type:Organization
Organization Name:SOLUTIONS OF SOBRIETY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGENZOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-228-0269
Mailing Address - Street 1:13832 N 32ND ST STE C136
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5613
Mailing Address - Country:US
Mailing Address - Phone:833-607-6237
Mailing Address - Fax:
Practice Address - Street 1:13832 N 32ND ST STE C136
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5613
Practice Address - Country:US
Practice Address - Phone:833-607-6237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1760775837Medicaid
AZ1972962082Medicaid