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General NPI Number Information
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NPI Number | 1659062115
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Entity Type | Organization
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Legal Business Name | SOBRIUS AT BASSETT
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 9850 VIRGINIA AVE
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City | BASSETT
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State | VA
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Zip | 24055-5909
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Country | US
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Telephone | 276-336-4331
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Fax |
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Provider Business Mailing Address
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Address Line | 506 CLIFFVIEW RD
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City | GALAX
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State | VA
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Zip | 24333-5084
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Country | US
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Telephone | 276-601-2736
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Fax |
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Authorized Official
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Title or Position | CFO, SOBRIUS
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Name | MR. DOUGLAS ALLAN FULLAWAY
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Credential |
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Telephone | 503-329-6687
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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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