MEDICARE: SMITH'S SOBER LIVING HOUSE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1134086820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH'S SOBER LIVING HOUSE

Provider Business Mailing Address
First Line	:	1462 W LEXINGTON AVE
Second Line	:
City	:	WINCHESTER
State	:	KY
Zip	:	40391-1294
Country	:	US
Telephone Number	:	859-355-5233
Fax Number	:

Provider Business Practice Location Address
First Line	:	1462 W LEXINGTON AVE
Second Line	:
City	:	WINCHESTER
State	:	KY
Zip	:	40391-1294
Country	:	US
Telephone Number	:	859-355-5233
Fax Number	:

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	ALLISON SCROGGINS
Credential	:
Telephone Number	:	859-447-6934

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	03/23/2026

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