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General NPI Number Information
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NPI Number | 1518884923
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Entity Type | Organization
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Legal Business Name | BE BRAVE SOBER LIVING ,INC
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Dates
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Enumeration Date | 07/06/2026
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Last Update Date | 07/06/2026
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Provider Practice Location Address
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Address Line | 15394 BAXTER ST
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City | VICTORVILLE
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State | CA
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Zip | 92394-2515
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Country | US
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Telephone | 724-252-7283
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Fax |
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Provider Business Mailing Address
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Address Line | 16271 GREEN HILL DR
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City | VICTORVILLE
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State | CA
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Zip | 92394-1463
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Country | US
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Telephone | 760-963-2283
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LOUIS MICHAEL JETT JR.
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Credential |
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Telephone | 760-963-2283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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