Provider Demographics
NPI:1447864202
Name:SOMA CARE, LLC
Entity type:Organization
Organization Name:SOMA CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:480-550-7460
Mailing Address - Street 1:6944 E BROADWAY RD STE A
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-1916
Mailing Address - Country:US
Mailing Address - Phone:480-550-7460
Mailing Address - Fax:480-459-2805
Practice Address - Street 1:6944 E BROADWAY RD STE A
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-1916
Practice Address - Country:US
Practice Address - Phone:480-550-7460
Practice Address - Fax:480-459-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty