Provider Demographics
NPI:1053127134
Name:CASA SOBRIA, LLC
Entity type:Organization
Organization Name:CASA SOBRIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COFFMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:405-900-3775
Mailing Address - Street 1:1832 NE 25TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-3342
Mailing Address - Country:US
Mailing Address - Phone:405-900-3775
Mailing Address - Fax:405-456-6900
Practice Address - Street 1:1832 NE 25TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-3342
Practice Address - Country:US
Practice Address - Phone:405-900-3775
Practice Address - Fax:405-456-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit