Healthcare Provider Details

I. General information

NPI: 1386777555
Provider Name (Legal Business Name): SOBRIETY HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 W. GRAND BLVD.
DETROIT MI
48208
US

IV. Provider business mailing address

2081 W. GRAND BLVD.
DETROIT MI
48208
US

V. Phone/Fax

Practice location:
  • Phone: 313-895-0500
  • Fax: 313-895-9503
Mailing address:
  • Phone: 313-895-0500
  • Fax: 313-895-9503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number820123
License Number StateMI

VIII. Authorized Official

Name: DANA SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 313-895-0500