Basic Information
| Provider Information | |||||||||
| NPI: | 1447805114 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOBRIETY NOW LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 S BROAD ST STE 2230 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191101021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2677049669 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 S BROAD ST STE 2230 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191101021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2677049669 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2019 | ||||||||
| LastUpdateDate: | 10/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | KIKER | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8564981243 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.