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General NPI Number Information
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NPI Number | 1861161531
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Entity Type | Organization
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Legal Business Name | SOBER SPACES ASSERTIVE COMMUNITY TREATMENT INC.
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 123 NW 13TH ST STE 209
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City | BOCA RATON
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State | FL
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Zip | 33432-1618
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Country | US
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Telephone | 561-961-8787
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Fax |
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Provider Business Mailing Address
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Address Line | 123 NW 13TH ST STE 209
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City | BOCA RATON
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State | FL
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Zip | 33432-1618
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Country | US
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Telephone | 561-961-8787
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. JOSEPH WYLIE
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Credential |
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Telephone | 561-416-9711
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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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