=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699316265
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOBER DISTRICT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2019
-----------------------------------------------------
Last Update Date | 10/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15373 VALLEY VISTA BLVD
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-3810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-500-3943
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6628 VAN NUYS BLVD
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405-4617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-500-3943
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ARAM KAPIYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-500-3943
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------