Organization
SOBER NATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES M MISJA M.D. (MEDICAL DOCTOR/ OWNER)
(937) 260-3156
Entity
Organization
Contact information
Practice address
226 WONDERLY AVE, OAKWOOD, OH 45419-1755
(937) 999-2561
(937) 221-8242
Mailing address
226 WONDERLY AVE, OAKWOOD, OH 45419-1755
(937) 999-2561
(937) 221-8242
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
FM1575692
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0051749
—
OH
05
—
0117002
—
OH
Enumeration date
10/04/2016
Last updated
10/04/2016
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