Healthcare Provider Details

I. General information

NPI: 1336946631
Provider Name (Legal Business Name): ALL IN SOBER LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 DARLENE ST
SAINT PAUL MN
55119-3004
US

IV. Provider business mailing address

1009 166TH STREET
HAMMOND WI
54015
US

V. Phone/Fax

Practice location:
  • Phone: 763-415-0488
  • Fax:
Mailing address:
  • Phone: 763-415-0488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE C TAN
Title or Position: OWNER
Credential:
Phone: 651-338-8512