Organization
SOBER LIVING IN MADISON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRZO KHASIMOV (PRESIDENT)
(608) 520-7142
Entity
Organization
Contact information
Practice address
2101 N SHERMAN AVE, MADISON, WI 53704-3932
(608) 520-7142
Mailing address
2101 N SHERMAN AVE, MADISON, WI 53704-3932
(608) 520-7142
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
10/13/2022
Last updated
10/14/2022
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