Healthcare Provider Details

I. General information

NPI: 1376088724
Provider Name (Legal Business Name): SOBRIETY CENTERS OF NEW HAMPSHIRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 04/06/2022
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MAIN STREET
ANTRIM NH
03440
US

IV. Provider business mailing address

55 MAIN ST
ANTRIM NH
03440
US

V. Phone/Fax

Practice location:
  • Phone: 603-365-8335
  • Fax:
Mailing address:
  • Phone: 603-280-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number04192
License Number StateNH

VIII. Authorized Official

Name: ROBERT DRAPER
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 603-913-4683