MEDICARE: SOBER FIRST, LLC

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1760008254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOBER FIRST, LLC

Provider Business Mailing Address
First Line	:	4415 EUCLID AVE STE 204
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-3758
Country	:	US
Telephone Number	:	857-206-0569
Fax Number	:

Provider Business Practice Location Address
First Line	:	4415 EUCLID AVE STE 204
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-3758
Country	:	US
Telephone Number	:	857-206-0569
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. WENDY WARRINGTON
Credential	:
Telephone Number	:	419-508-1729

Provider Enumeration Date	:	06/19/2020
Last Update Date	:	06/19/2020

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Directions to “SOBER FIRST, LLC ” Practice Location

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