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General NPI Number Information
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NPI Number | 1912764754
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Entity Type | Organization
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Legal Business Name | 502 SOBRIETY SOLDIERS LLC
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Dates
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Enumeration Date | 02/28/2024
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 726 S PRESTON ST
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City | LOUISVILLE
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State | KY
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Zip | 40203-2320
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Country | US
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Telephone | 502-718-1495
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Fax |
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Provider Business Mailing Address
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Address Line | 2133 W MARKET ST
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City | LOUISVILLE
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State | KY
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Zip | 40212-1532
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | SARAH BROCK
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Credential | M. ED TCADC
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Telephone | 859-693-7644
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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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