NPIMap

Organization Active NPI

Sobertec LLC

  • Substance Abuse Rehabilitation Facility
  • San Clemente, CA
National Provider Identifier
1932504024
Registry record updated Dec 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
300254BP Issued in CA
Legal business name
SOBERTEC LLC
Practice address
610 Avenida Acapulco
San Clemente, CA 92672-2461
Phone
(949) 877-3656
NPI assigned
Oct 31, 2014
Last updated
Dec 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2019

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

Authorized official

Name
Darryle Mackelvey
Title
Supervisor
Phone
(714) 948-6086

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 300254BP CA Primary

Addresses

Primary practice location

610 Avenida Acapulco
San Clemente, CA 92672-2461

Mailing address

2350 SE Bristol St
Newport Beach, CA 92660-1528

National Provider Directory

National Provider Directory
Tax ID family
Sobertec LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2350 SE Bristol St
Newport Beach, CA 92660

NPI Registry JSON

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

{
    "created_epoch": "1414713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576627200000",
    "number": "1932504024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 SE BRISTOL ST",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926601528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 AVENIDA ACAPULCO",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926722461",
            "telephone_number": "949-877-3656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOBERTEC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-31",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A",
        "authorized_official_last_name": "MACKELVEY",
        "authorized_official_first_name": "DARRYLE",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "714-948-6086"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "300254BP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Clemente, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; 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.