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A SOBER WAY HOME

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SANDRA TILLMAN (PRESIDENT)
(928) 776-3073
Entity
Organization

Contact information

Practice address
609 W GURLEY ST, PRESCOTT, AZ 86305-3619
(928) 776-3073
Mailing address
609 W GURLEY ST, PRESCOTT, AZ 86305

Taxonomy

Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
BH3230
AZ
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
BH3230
AZ

Other

Enumeration date
10/23/2009
Last updated
10/23/2009
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