Provider Demographics
NPI:1508747775
Name:SOBERENITY
Entity type:Organization
Organization Name:SOBERENITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:CHW, PWS, CRM-FP
Authorized Official - Phone:971-434-7146
Mailing Address - Street 1:91158 YOUNGS RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-8131
Mailing Address - Country:US
Mailing Address - Phone:971-434-7146
Mailing Address - Fax:
Practice Address - Street 1:91158 YOUNGS RIVER RD
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-8131
Practice Address - Country:US
Practice Address - Phone:971-434-7146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty