Healthcare Provider Details

I. General information

NPI: 1376965228
Provider Name (Legal Business Name): SOS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 S 9TH ST
NOBLESVILLE IN
46060-2614
US

IV. Provider business mailing address

136 S. 9TH STREET
NOBLESVILLE IN
46060
US

V. Phone/Fax

Practice location:
  • Phone: 317-770-7070
  • Fax:
Mailing address:
  • Phone: 317-770-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREWS DOLLARD
Title or Position: OWNER/PRESIDENT
Credential: J.D
Phone: 317-770-7070