MEDICARE: SOBER LIVING PROPERTIES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1093152290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOBER LIVING PROPERTIES, LLC

Provider Business Mailing Address
First Line	:	3434 E BENGAL BLVD # 220
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-5803
Country	:	US
Telephone Number	:	801-386-9889
Fax Number	:	801-386-9890

Provider Business Practice Location Address
First Line	:	1027 E MILLCREEK WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2015
Country	:	US
Telephone Number	:	801-386-9889
Fax Number	:	801-386-9890

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR / CEO
Name	:	MICHAEL BROWN
Credential	:
Telephone Number	:	801-557-9788

Provider Enumeration Date	:	05/29/2013
Last Update Date	:	04/28/2021

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