Healthcare Provider Details

I. General information

NPI: 1083617344
Provider Name (Legal Business Name): SOBRIETY HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 ACOMA ST
DENVER CO
80223-1429
US

IV. Provider business mailing address

107 ACOMA ST
DENVER CO
80223-1429
US

V. Phone/Fax

Practice location:
  • Phone: 303-722-5746
  • Fax: 303-777-7601
Mailing address:
  • Phone: 303-722-5746
  • Fax: 303-777-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number1072-02
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1072-02
License Number StateCO

VIII. Authorized Official

Name: MR. WILLIAM ANDREW DOLAN
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW CACIII
Phone: 303-722-5746