Soul Surgery LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

SOUL SURGERY LLC

Practice address

14362 N. Frank Lloyd Wright
#B111
Scottsdale, AZ 85260

Phone

(480) 912-3105

Fax

(480) 912-3106

NPI assigned

Apr 7, 2017

Last updated

Jan 31, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Regina Shakespeare

Title

Billing Compliance Officer

Phone

(928) 554-5633

Specialties & licenses 6

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580428800000",
    "number": "1871026674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14362 N. FRANK LLOYD WRIGHT",
            "address_2": "#B111",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "85260",
            "telephone_number": "480-912-3105",
            "fax_number": "480-912-3106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14362 N. FRANK LLOYD WRIGHT",
            "address_2": "#B111",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "85260",
            "telephone_number": "480-912-3105",
            "fax_number": "480-912-3106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUL SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-07",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A",
        "authorized_official_last_name": "SHAKESPEARE",
        "authorized_official_first_name": "REGINA",
        "authorized_official_title_or_position": "BILLING COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "928-554-5633"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "OTC7755",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "364SP0809X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": "AZ",
            "license": "OTC7755",
            "primary": false
        },
        {
            "code": "364SP0809X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "AZ",
            "license": "OTC8541",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria M Soto Santiago
• Anyurisa Soto-Williams
• Benjamin Soto, SLPA
• Derek Soto, RBT
• Olufolake Olutoyin Soto, FNP-BC
• Soul Surgery Silkworth Center LLC
• Soul Surgery Wilson Smith Center LLC
• Tonya Lee Soules, OT
• Soulspark, LLC
• Karla Sourasky Olmos, L. AC.

• Substance Abuse Rehabilitation Facility in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Substance Abuse Rehabilitation Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.