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General NPI Number Information
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NPI Number | 1992973341
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Entity Type | Organization
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Legal Business Name | SOBRIETY THROUGH OUT PATIENT INC
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 2534-36 N. BROAD ST SUITE 200
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City | PHILADELPHIA
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State | PA
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Zip | 19132
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Country | US
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Telephone | 215-227-7867
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Fax | 215-227-5268
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Provider Business Mailing Address
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Address Line | 2534-36 N. BROAD ST SUITE 200
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City | PHILADELPHIA
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State | PA
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Zip | 19132
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Country | US
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Telephone | 215-227-7867
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Fax | 215-227-5268
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Authorized Official
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Title or Position | CEO
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Name | DR. FREDERICK HEARD
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Credential | PHD
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Telephone | 215-227-7867
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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 | 128790
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License Number State | PA
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