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NPI Code Detail

MEDICARE: SOBER COLLEGE ENVIRONMENTS, LLC

MEDICARE: SOBER COLLEGE ENVIRONMENTS, 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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1366724676
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOBER COLLEGE ENVIRONMENTS, LLC
Provider Business Mailing Address
First Line : 6022 VARIEL AVE
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-3719
Country : US
Telephone Number : 818-274-0304
Fax Number : 818-274-0309
Provider Business Practice Location Address
First Line : 6022 VARIEL AVE
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-3719
Country : US
Telephone Number : 818-274-0304
Fax Number : 818-274-0309
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : MRS. AIMEE NOEL
Credential : LCSW
Telephone Number : 818-274-0304
Provider Enumeration Date : 09/13/2011
Last Update Date : 04/05/2018

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Directions to “SOBER COLLEGE ENVIRONMENTS, LLC ” Practice Location

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