Provider Demographics
NPI:1679067946
Name:CAME TO PASS SOBER LIVING RECOVERY LLC
Entity type:Organization
Organization Name:CAME TO PASS SOBER LIVING RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL MORAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-864-9702
Mailing Address - Street 1:1072 E OLD CANYON CT
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5924
Mailing Address - Country:US
Mailing Address - Phone:928-864-9702
Mailing Address - Fax:
Practice Address - Street 1:1072 E OLD CANYON CT
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5924
Practice Address - Country:US
Practice Address - Phone:928-864-9702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5453251B00000X, 261QR0405X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251B00000XAgenciesCase Management
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility