Healthcare Provider Details

I. General information

NPI: 1922933084
Provider Name (Legal Business Name): UP & OUT SOBER LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 VICTORIA SQ
FREDERICK MD
21702-1109
US

IV. Provider business mailing address

PO BOX 4034
FREDERICK MD
21705-4034
US

V. Phone/Fax

Practice location:
  • Phone: 240-529-2995
  • Fax:
Mailing address:
  • Phone: 240-529-2995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KOREY SHORB
Title or Position: OWNER/OPERATOR
Credential:
Phone: 240-529-2995