MEDICARE: BRI RAE SOBER LIVING AND ADDICTION SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
3	343900000X	Non-emergency Medical Transport (VAN)
4	174200000X	Meals Provider
5	177F00000X	Lodging Provider
6	251B00000X	Case Management Agency
7	251C00000X	Developmentally Disabled Services Day Training Agency
8	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1043903628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRI RAE SOBER LIVING AND ADDICTION SERVICE

Provider Business Mailing Address
First Line	:	900 CHINABERRY CIR S
Second Line	:
City	:	MACEDONIA
State	:	OH
Zip	:	44056-2324
Country	:	US
Telephone Number	:	216-270-9101
Fax Number	:

Provider Business Practice Location Address
First Line	:	1256 MELBOURNE RD
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-4137
Country	:	US
Telephone Number	:	216-868-5182
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NAKITA BROCK-DARLING
Credential	:
Telephone Number	:	216-270-9101

Provider Enumeration Date	:	05/31/2023
Last Update Date	:	05/31/2023

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