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General NPI Number Information
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NPI Number | 1871445817
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Entity Type | Organization
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Legal Business Name | SD SOBER LIVING LLC
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Dates
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Enumeration Date | 02/12/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 10320 PROSPECT AVE
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City | SANTEE
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State | CA
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Zip | 92071-4415
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Country | US
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Telephone | 619-625-0769
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Fax |
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Provider Business Mailing Address
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Address Line | 1356 PEPPERVILLA DR
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City | EL CAJON
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State | CA
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Zip | 92021-1212
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Country | US
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Telephone | 619-625-0769
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | NICHOLAS DEREN
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Credential |
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Telephone | 619-625-0769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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