Healthcare Provider Details

I. General information

NPI: 1598507873
Provider Name (Legal Business Name): SOBER SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/10/2024
Certification Date: 06/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 53RD ST E APT 201
WILLISTON ND
58801-7122
US

IV. Provider business mailing address

608 53RD ST E APT 201
WILLISTON ND
58801-7122
US

V. Phone/Fax

Practice location:
  • Phone: 701-310-5162
  • Fax:
Mailing address:
  • Phone: 701-310-5162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER JURAK
Title or Position: DIRECTOR
Credential:
Phone: 701-310-5162