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General NPI Number Information
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NPI Number | 1881488377
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Entity Type | Organization
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Legal Business Name | THE SOBRIETY SHOP LLC
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 1015 COLUSA ST
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City | VALLEJO
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State | CA
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Zip | 94590-4525
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Country | US
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Telephone | 510-612-7285
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 PARK ST STE 642
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City | ALAMEDA
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State | CA
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Zip | 94501-4507
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Country | US
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Telephone | 510-612-7285
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TORRE DRUE SAMONEK
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Credential |
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Telephone | 510-612-7285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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