Provider Demographics
NPI:1285474510
Name:POTENXIAL BY SOFY LLC
Entity type:Organization
Organization Name:POTENXIAL BY SOFY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-230-7139
Mailing Address - Street 1:1402 JANANN AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-1426
Mailing Address - Country:US
Mailing Address - Phone:817-899-3490
Mailing Address - Fax:
Practice Address - Street 1:1402 JANANN AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-1426
Practice Address - Country:US
Practice Address - Phone:817-899-3490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOFIA ROSAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No273R00000XHospital UnitsPsychiatric Unit