Healthcare Provider Details

I. General information

NPI: 1538409362
Provider Name (Legal Business Name): SOBRIETY HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W. 1ST AVE.
DENVER CO
80223-1429
US

IV. Provider business mailing address

121 ACOMA ST
DENVER CO
80223-1429
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number107200
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM DOLAN
Title or Position: CEO/EXECUTIVE DIRECTOR
Credential: LCSW, CACIII
Phone: 720-381-4332