Healthcare Provider Details

I. General information

NPI: 1023701158
Provider Name (Legal Business Name): EAU CLAIRE SOBER LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 LINCOLN AVE
EAU CLAIRE WI
54701-4015
US

IV. Provider business mailing address

334 LINCOLN AVE
EAU CLAIRE WI
54701-4015
US

V. Phone/Fax

Practice location:
  • Phone: 800-989-3068
  • Fax:
Mailing address:
  • Phone: 800-989-3068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE MARKQUART
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 800-989-3068