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NPI Code Detail

MEDICARE: SOBRIETY HOUSE, INC.

MEDICARE: SOBRIETY HOUSE, INC.
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
1324500000XSubstance Abuse Rehabilitation Facility107200CO
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467792242
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOBRIETY HOUSE, INC.
Provider Business Mailing Address
First Line : 121 ACOMA ST
Second Line :
City : DENVER
State : CO
Zip : 80223-1429
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 121 ACOMA ST
Second Line :
City : DENVER
State : CO
Zip : 80223-1429
Country : US
Telephone Number : 720-381-4332
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. WILLIAM DOLAN
Credential : LCSW, CAC III
Telephone Number : 720-381-4332
Provider Enumeration Date : 02/15/2013
Last Update Date : 11/05/2020

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1538409362 — SOBRIETY HOUSE, INC.
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